LAUSR

Abstract Background Delays to breast cancer diagnosis and treatment initiation are associated with worsened outcomes. However, population-based screening is impractical in many low-income and middle-income countries (LMICs) because of resource constraints and a lack of capacity to effectively diagnose and treat screen-detected disease. Mexico and Peru have similar mortality-to-incidence ratios for breast cancer. Unlike Peru, Mexico has attempted to implement mammography screening, although it remains opportunistic with low (20%) national coverage rates. The aim of this study was to compare delays and describe barriers to care among breast cancer patients in Mexico and Peru. Methods This international cross-sectional study included breast cancer patients interviewed at four public cancer hospitals in Mexico City between 2009 and 2011, and a federally-funded regional cancer institute in Trujillo, Peru in 2015. A Breast Cancer Delays Questionnaire, developed and validated in Mexico and modified for Peru, was administered to breast cancer patients during routine hospital visits at each location. Patient-related, diagnostic, and treatment delays were quantified, and barriers to care identified. Findings We included data from 597 Mexican women and 113 Peruvian women. Age at diagnosis did not differ between countries (53 years [Mexico] vs 54 years [Peru], p=0·266). Most women in both countries had breast cancer detected by symptoms (84% [Mexico] vs 93% [Peru]; p Interpretation Improved diagnostic and referral systems are necessary to reduce delays to breast cancer care in Mexico and Peru. Such improvements are prerequisites to the establishment of maximally effective mammography screening programmes in LMICs. Funding NIH Research Training Grant 3R25TW009345 awarded to the Northern Pacific Global Health Fellows Program by the Fogarty International Center and Institutes at the NIH; the Fulbright Scholar Program, a program of the United States Department of State Bureau of Educational and Cultural Affairs; and the Mexican National Council of Science and Technology (grant CONACYT/SSA/IMSS/ISSSTE SALUD-2007-C01-69,439).