Female breast cancer late presentation in Saudi Arabia: a mixed methods study

Breast cancer is one of the most common cancers in the developed world, and it is rapidly increasing in developing countries, such as Saudi Arabia. Early stage diagnosis of breast cancer is an aim that would enable better outcomes, especially survival. The impact of early presentation of breast cancer on prognosis is so profound that the investigation into factors influencing late presentation of female breast cancer in Saudi Arabia is vital to attain timely diagnoses. A mixed methods research design was used to gain insight into the factors associated with late presentation and the reasons for their association; quantitative and qualitative data were collection, analysed, and integrated from various data sets and perspectives. Phase I of this thesis comprised a review of Middle East studies in the published literature about factors associated with late-presentation breast cancer. The review confirmed the need to conduct this research and the originality of such research. Phase II comprised collection of breast cancer-related data from the Saudi National Cancer Registry. In total, 10,663 records for female breast cancer were analysed to investigate the relationship between stage at diagnosis and five independent variables: age, year of diagnosis, nationality, place of residence, and marital status. Analysis found all variables except marital status to be significant. The quantitative findings were used for sampling participants in Phase III, which comprised semi-structured interviews with 19 women diagnosed with breast cancer at early and late stages. The analysis found an interaction between factors associated with late presentation, in particular with age. Furthermore, the results provided insight into contextual factors influencing time to seek medical care and diagnosis following symptom recognition. Phase IV comprised a reanalysis of quantitative data to investigate the interaction between variables and stage at diagnosis, which was prompted by the qualitative findings. The analysis illustrated the characteristics of women who typically receive a late-stage diagnosis. These include living in regions with less oncology care and age older than 58 years or younger than 42 years. In further analysis, inference was then generated by integrating findings: explaining the factors found in the quantitative results through integration with the qualitative findings and then comparing these results with findings in the literature. This thesis presents an innovative platform for investigating a complex health problem and offers answers to what factors might associate with late presentation of female breast cancer in Saudi Arabia and why.