Background
Adequate access to healthcare is crucial to deliver a comprehensive, systematic diagnostic
evaluation of a breast mass. Though the etiology of breast masses is vast, including both benign
and malignant causes, a missed diagnosis of breast cancer should never occur in any part of the
world. Globally, breast cancer is the most frequently diagnosed malignancy with more than a
million cases each year. Though breast cancer rates are reportedly increasing in Nepal, there are
limited data on the prevalence of undiagnosed breast masses.
Methods
A countrywide survey was administered in Nepal using the Surgeons OverSeas Assessment of
Surgical Need (SOSAS) from May 25th to June 12th, 2014. Fifteen of the 75 districts of Nepal were
randomly chosen proportional to population. In each district, three clusters, two rural and one
urban, were randomly selected. In total, 1,350 households and 2,695 individuals were
interviewed. As part of the survey, responses were noted to the presence and duration of a
breast mass, health-seeking behavior and access to surgical care for this problem. Women older
than 18 were included in this study.
Results
A total of 2,695 individuals were surveyed with a response rate of 97%. Of the 955 women over
age 18 surveyed, 15 reported a breast mass (1.6%, 95% CI 1% to 2.6%). Mean age was 39.7.
Eight had a mass for over one year, 3 for one year or less and 4 for less than one month. Eight
had sought healthcare and for these, 3 had a minor procedure performed. The remaining 5 did
not receive surgical care due to no need (n=1), fear/no trust (n=3) and no money (n=1). Of the 7
who did not seek healthcare, reasons included: no need (2) and fear/no trust (5). Not including
those who did not perceive a need for healthcare, a total of 9 had an unmet surgical need for a
breast mass. Extrapolation shows that potentially 69,900 women aged 25 and above in Nepal
have undiagnosed breast masses.
Conclusion
Untreated breast masses affect a significant number of women in Nepal and the true prevalence
likely exceeds our estimates, which are based on self-reported data. While not all breast masses
are malignant, many women would benefit from increased education, screening and possible
treatment. Efforts to improve confidence in the system are needed so that women will seek out
medical care and benefit from increased awareness, screening, diagnosis and treatment of breast
diseases.