Clinical features, diagnosis, and referral of women with breast abnormalities in primary health care settings in rural Ethiopia: a retrospective record analysis

Breast cancer is the most commonly diagnosed cancer among women worldwide. At the primary health care level, understanding the magnitude of different breast abnormalities and current referral practices can improve patient-centred health care services, enhance patient education and awareness, and encourage interdisciplinary collaboration to enhance breast cancer outcomes, in line with the World Health Organization Breast Cancer Global Initiative (GBCI) Pillar One Goal. Thus, this study aims to explore the burden of breast-related abnormalities and their clinical features during presentation, diagnosis, treatment, and referral practices at the primary health care level in Ethiopia. A facility-based retrospective record analysis was conducted in 2022. All documented cases of breast abnormalities among women at outpatient departments of 17 primary health care facilities were included. Of all women who presented at outpatient departments, breast abnormalities were estimated at 5 per 1,000 women patients. The proportion of suspected diagnoses of breast cancer among women with breast-related complaints was 7.5% (n = 25/335). Among women with breast-related complaints, half (50.7%, n = 170) presented with a complaint of breast pain, and approximately half (47.2%, n = 158) presented to the health facility within < 1 month from the onset of symptoms. More than half of the women (63.0%, n = 211) were diagnosed with breast infection/mastitis. A total of 57.1% (n = 194) of women with breast complaints were treated with antibiotics and pain medication. The proportion of women who received surgical treatment at primary hospitals was 2.6% (n = 14). Overall, the study found a 6.0% (n = 20) referral rate and 23.0% (n = 101/436) incomplete patient record. Women in Ethiopia often present to primary health care facilities with breast pain and suspected mastitis. In this study, a suspected diagnosis of breast cancer was found in 1 in 13 cases. This highlights the need for diagnostic services and coordination to distinguish between benign conditions and serious malignant diseases. Strengthening primary health care services in terms of symptom recognition, referral, and feedback communications, and documentation are essential to achieve the GBCI goal on the reduction of breast cancer mortality.