Asociación entre síntomas de presentación del cáncer de mama y factores clínicos y sociodemográficos

Abstract

INTRODUCTION. Worldwide, breast cancer is the most common followed by lung and prostate cancer, and its incidence rate in women triples that of colorectal cancer and lung cancer (Ferlay et al., 2021). Survival in breast cancer is directly proportional to the stage at the time of diagnosis (Gómez-Acebedo et al., 2020). Participation in cancer screening programs and early diagnosis are essential for their survival. There are studies on the sociodemographic characteristics associated with participation in screening programs, and a positive association has been found with older age, higher level of education, being married, and higher socioeconomic status (Martín-López, 2010). The most important presenting symptom of breast cancer is noticing a lump in the breast, and it is the only one that is usually included as a potential sign or symptom for referral to specialized care. OBJECTIVES: 1-To provide data on the frequency and typology of the presenting symptom of breast cancer in Spain. 2-Study the association between symptoms of breast cancer presentation and sociodemographic factors. 3-Study the association between symptoms of breast cancer presentation and clinical characteristics and patient history. 4-Study the association between symptoms of breast cancer presentation and clinical characteristics of the tumor. METHODOLOGY: 836 histologically confirmed symptomatic breast cancer patients were recruited from 18 hospitals in 10 regions of Spain. The information was obtained through a computerized face-to-face interview and with reviews of medical records. A variable on the first symptom was created after applying an algorithm to classify the responses reported by the patients. Standard statistical tests for parametric and nonparametric variables were used (Siegel et al., 1988). RESULTS AND CONCLUSIONS: The most frequent presenting symptom in breast cancer is the lump in the breast (77.4%), with changes in the breast being the second most frequent (11.6%). There are other symptoms that appear less frequently: pain in the breast (7.5%), asthenia (2.9%), secretions other than blood, and a painful lump in the breast in 2.6% each. Breast changes included nipple retraction, retraction of other parts of the breast, hard chest, itchy chest, and changes in the shape or color of the breast. Geographical differences were observed in the proportion of women who reported a lump in the breast as a symptom. Regarding referring a lump in the breast, an inverse trend was observed with the educational level, although it did not obtain statistical significance. A slight trend is observed, between the increase in age and the increase in the frequency of reporting changes in the breast. We found an inverse association between Body Mass Index (BMI) and reporting a lump in the breast as a presenting symptom of breast cancer, while having a history of first-degree non-breast cancer was associated with reporting no type of first symptom. The women who reported a lump in the breast as the initial symptom tended to have tumors with earlier TNM stages, with a less aggressive grade. Finally, we have observed differences between the intervals between the date of the first symptom and diagnosis and reporting a lump in the breast as the first symptom, the intervals being shorter when it comes to reporting a lump in the breast. The same occurred with the intervals first symptom-start of surgical treatment, and first symptom-start of treatment.