Social-Ecological Perspectives On Breast Cancer Care Seeking Patterns In Karnataka, India

6542 Background: India bears approximately ten percent of the global burden of breast cancer but has lower survival rates than developed countries possibly due to delays in diagnosis and treatment. Early recognition and diagnosis of breast cancer potentially offers the opportunity for treating the early stage disease and potentially improve treatment outcomes. The underlying factors responsible for delays in access to treatment are not well-defined. There are few published studies that attempt to understand the factors that facilitate or impede care-seeking and timely diagnosis and treatment of breast cancer in the Indian context. Methods: Using the social-ecological theory of behaviour, we conducted semi-structured in-depth interviews with 27 breast cancer patients and 22 primary caregivers receiving care at a non-profit tertiary care hospital in Bengaluru, India to understand how care-seeking and the timing of diagnosis and treatment were influenced by multilevel factors, including knowledge and awareness of breast cancer, family and community reactions to symptoms and diagnosis, and availability and access to different types of clinical services. Results: Factors that impeded timely diagnosis and treatment were women's lack of awareness about the signs and symptoms and the need for timely care-seeking, competing family/household priorities, fear of a cancer diagnosis, inconsistent pathways through the healthcare system for diagnosis and treatment, financial constraints, and fear and stigma related to cancer.The main facilitators in care seeking included hope of getting cured, financial and social support from the family. Conclusions: A range of multilevel factors seem to be associated with women's breast cancer care trajectories. Qualitative findings suggest that multifaceted interventions that address knowledge, fear and stigma among individuals, families and communities and that improve access to health care through financial protection may be needed to downstage breast cancer in India.These emerging findings from our qualitative research are being used to develop a quantitative instrument to further study this issue using a more representative sample.