Factors Associated with Delayed Presentation of Breast cancer in West Africa: A Systematic Review​

Background: Delayed presentation in patients with breast cancer is associated with worse treatment outcome and increased mortality rates. Rates of delayed presentation are more prevalent in countries with emerging economies including West Africa where it is estimated that 7 in 10 women delay presentation. Factors associated with the delayed presentation in West Africa are not well understood.

Aim: The aim of this systematic review was to identify the factors associated with delayed presentation of breast cancer in West Africa.

Synthesis of Results: Eligibility Criteria We included observational studies, where fieldwork was conducted in West Africa, that reported factors associated with delayed presentation in women with breast cancer. No language or date restrictions were applied.Four databases (CINAHL, EMBASE, MEDLINE, and Web of Science) were last searched on the 3rd  April 2025. Two researchers undertook the title, abstract and full-text screening. Risk of bias was determined using Effective Public health Practice Project (EPHPP) critical appraisal tool. Synthesis of

Results: A narrative synthesis was conducted because meta‑analysis was not feasible due to substantial heterogeneity across the included studies in study design, measurement of delayed presentation, definitions of key variables, and variability in reported outcomes.

Results: In total 11 observational studies involving 5,445 participants were included in the review. Included studies were all cross-sectional surveys. We identified 14 factors associated with delayed presentation. Common factors associated with delayed presentation (identified in all included studies) were income or financial status, low educational attainment, religiosity or spirituality, a preference for herbal or traditional treatment and the fear of mastectomy.

Discussion: We identified several factors that seemingly impact women’s decision to delay seeking treatment for breast cancer in West Africa that are different to those identified in other countries particularly ones with more advanced health care systems. However, the quality of the research does not give us confidence in the findings.

Limitations of the Evidence: The overall quality of evidence in this review was limited by methodological weaknesses, reporting inaccuracies, and missing data across the included studies. Consequently, the certainty of the evidence is low, and caution should be exercised when interpreting and applying these findings in practice.

Interpretation of the Results: Timely treatment of breast cancer is important to ensuring positive outcomes for patients. Delayed presentation is common in West Africa possibly because of important culturally specific factors including education, religiosity and distance to access health services.