Table 1 Questionnaire for assessment of diagnosis delay in women with breast cancer in Libya
File number | ||
|---|---|---|
Age (years) | ||
Address | ||
Occupation | House wife | |
Employee | ||
Marital status | Married | |
Single | ||
Education | Literate | |
Illiteracy | ||
Obstetric history | Age of menarche | |
Age at first pregnancy | ||
Oral contraceptive pills | ||
Number of births | ||
Breast feeding | ||
Menopausal status | Pre-menopausal | |
Pos-menopausal | ||
Family history | Positive | |
Negative | ||
History of benign breast disease | Yes | |
No | ||
Breast self examination | Yes | |
No | ||
First symptoms | Lump | |
Nipple discharge | ||
Skin changes | ||
Systemic | ||
Mode of First symptoms detection (first symptoms) | Accidental | |
Breast self examination | ||
Clinical examination | ||
Action taken by the patient at appearance of the first symptoms | Consult the doctor immediately | |
Delay | Duration of delay | |
Reasons of delay | ||
Action taken by the doctor at the first visit | Refer the patient | |
Medical follow-up | ||
Duration of follow-up | ||
Duration between first symptoms and first visit to the doctor | ||
Duration between the first visit to the doctor and histopathological or cytological diagnosis | ||
Duration between the first symptoms and histopathological or cytological diagnosis. | ||
Clinical staging at time of the diagnosis (from the patients files) | ||