Direct and Indirect Associations of Sociodemographic Factors and Patient-Perceived Barriers With Delayed Breast Cancer Presentation: A Cross-Sectional Path Analysis

Abstract

Background: Delayed presentation remains a contributor to advanced-stage breast cancer (BC) diagnosis and poor outcomes. Although sociodemographic factors are known to influence presentation delay, patient-perceived barriers may play a role in help-seeking behavior. However, the association linking sociodemographic characteristics, patient-perceived barriers, and delayed presentation remains insufficiently understood. This study aimed to examine the direct and indirect associations between sociodemographic factors, patient-perceived barriers, and delayed BC presentation using a path analysis approach.

Methods: This cross-sectional study included 150 women with BC. Sociodemographic characteristics, presentation interval, and patient-perceived barriers were collected through medical records and semi-structured interviews. Patient-perceived barriers were identified through content analysis of open-ended responses. Path analysis was conducted to estimate direct, indirect, and total effects.

Results: None of the total indirect effects from sociodemographic variables to presentation delay through patient-perceived barriers were statistically significant. Five specific indirect pathways tested using the joint-significance approach were also non-statistically significant: age through fear of surgery (β = −0.002; P = 0.149), monthly income through fear of diagnosis (β = −0.029; P = 0.116), monthly income through fear of surgery (β = 0.047; P = 0.087), monthly income through preference for a female physician (β = 0.026; P = 0.135), and education through fear of surgery (β = 0.072; P = 0.051). Several sociodemographic factors showed significant direct associations with specific patient-perceived barriers. Increasing age was associated with lower fear of visiting health facilities (β = −0.245; P < 0.05) and lower fear of surgery (β = −0.149; P < 0.05). Higher income was associated with lower fear of diagnosis (β = −0.128; P < 0.05), higher fear of surgery (β = 0.170; P < 0.05), and greater preference for female physicians (β = 0.161; P < 0.05). Lower educational attainment was associated with higher fear of surgery (β = 0.283; P < 0.01), while unmarried status was associated with higher fear of healthcare costs (β = 0.383; P < 0.01) and lower likelihood of seeking complementary and alternative medicine (β = −0.130; P < 0.05). Several patient-perceived barriers were directly associated with delayed presentation, including fear of diagnosis (β = 0.165; P < 0.01), fear of surgery (β = 0.247; P < 0.01), painless symptoms (β = 0.367; P < 0.001), symptom minimization (β = 0.105; P < 0.05), perceived busyness (β = 0.244; P < 0.01), and preference for female physicians (β = 0.105; P < 0.05).

Conclusion: Although the hypothesized mediation of sociodemographic factors by patient-perceived barriers was not supported, several sociodemographic factors were associated with distinct barrier profiles, and several patient-perceived barriers were associated with delayed presentation. These findings highlight the importance of addressing modifiable barriers to promote earlier presentation and improve BC outcomes.