Introduction
Breast cancer is the most common cancer for women, with an estimated 685,000 fatalities worldwide in 2020.1 Fortunately, with the widespread availability of screening and the advancement of medical technology, the survival rate of breast cancer patients in developed countries has exceeded 80%.2 Meanwhile, the mortality rate has been reported to increase by up to two to three times with a delay of only 12 weeks in the initial diagnosis and subsequent treatment.3 Therefore, providing an appropriate approach for each patient’s situation is essential to encourage patient screening and consultation for early detection.4
Since the 2011 triple disaster (earthquake, tsunami, and nuclear disaster), more attention has been paid to disasters and crises as external factors affecting breast cancer screening and consultations. Several reports have indicated that breast cancer patients in Fukushima were reluctant to receive medical consultations after the disaster, resulting in prolonged refrains, with mortality rates increasing among those who delayed their consultations.5-7 Furthermore, under the ongoing COVID-19 pandemic, breast cancer patients’ refraining from seeing doctors and postponement or cancellation of surgeries and examinations have also been reported.8, 9
Several factors have been named relevant to medical consultation delays after disasters and crises such as reduction of health priorities due to the significant changes in the surrounding environment.7, 10 In addition, a post-disaster case study in Fukushima indicated that reduced support from family and friends was associated with delays in medical visits.11 Refraining from hospital visits due to the fear of being infected with the COVID-19 can also be interpreted in this context.9, 12 Further, personality factors have been also noted as possible factors associated with delays in hospital visits.13, 14
However, there have not been enough studies on breast cancer patients that systematically evaluated the factors such as lower health priorities, personality, and support from the surrounding community in patients who delayed their medical visits in actual cases of disasters and crises. Therefore, we took into consideration of contributions of these factors to the patient delay in crisis situations in this paper, by focusing on a breast cancer patient who visited our hospital for suspected breast cancer symptoms, interrupted her visits for as long as 2 years due to the state of emergency against the COVID-19 pandemic, and was diagnosed with advanced cancer.