Study links delays to stigma, gaps in early care
Irfan Tramboo
Srinagar, May 5: Women in Kashmir continue to present with advanced stages of breast cancer due to a mix of sociocultural stigma, delayed healthcare-seeking, and gaps in treatment access, a study conducted at SKIMS has found.
The study, published in The Journal of Medical Research (Wolters Kluwer–Medknow) by the Department of General and Minimal Access Surgery, analysed 30 cases of locally advanced breast cancer (LABC) between June 2020 and June 2024 and highlights how cultural norms and structural limitations combine to worsen outcomes in the region.
According to the researchers, all patients in the study were married women aged 32 to 60 years, with a mean age of 48. A majority (86.7%) belonged to rural areas, underscoring the disproportionate burden on populations with limited healthcare access.
The study notes that educational levels were low, averaging just three years of schooling, which it identifies as a key barrier to timely intervention.
Despite this, the researchers found that awareness did not necessarily lead to action.
Around 60% of women had noticed abnormalities but delayed seeking medical care, with the study attributing this gap to deep-rooted sociocultural factors rather than lack of knowledge alone.
As per the study, hesitation and embarrassment in discussing breast symptoms were the leading causes of delay, cited by 46.7% of patients.
Another 26.7% opted for traditional healing methods, while 13.3% reported fear of family abandonment.
The researchers observed severe clinical consequences of these delays. About 80% of patients presented with fungating breast masses, indicating advanced disease.
On average, women delayed seeking care for nearly 14 months, and most cases were diagnosed at stage III.
The study further found significant drop-offs across the treatment pathway. While all patients underwent initial consultation and biopsy, only 73.3% completed the full diagnostic workup.
Of these, 63.6% completed neoadjuvant therapy. Surgical treatment was performed in 85.7% of eligible patients, and 83.3% completed adjuvant therapy.
Overall, however, only 33.3% completed the entire treatment process, indicating major attrition at early stages.
According to the researchers, adherence improved among those who progressed beyond initial barriers, suggesting that early-stage engagement—diagnosis and initiation of treatment—remains the biggest challenge.
The study also highlights concerning mortality trends. Among patients who completed treatment and follow-up, 30% died, a rate higher than global averages for similar cases.
Researchers attribute nearly 60% of delays to cultural factors, including stigma, modesty concerns, reliance on traditional medicine, and fear of social consequences.
Economic and access-related issues were also noted but played a comparatively smaller role.
The researchers recommend a multi-pronged approach, including targeted community outreach in rural areas, involvement of local and religious leaders to counter stigma, and integration of breast health education into maternal and reproductive healthcare services.
They also emphasise the need for patient navigation systems and psychosocial support.
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