Analysis of Delays in Breast Cancer Treatment and Late-Stage Diagnosis in Kazakhstan

Objective: Although Kazakhstan has made significant investments to improve health and life expectancy of itspopulation, high cancer rates persist, with breast cancer being the most prevalent type. Factors contributing to delaysin treatment and late staging for breast cancer patients were assessed. Methods: A retrospective follow-up studywith registry data identified 4,248 breast cancer patients in sixteen regions of Kazakhstan in 2014. We used logisticregressions to estimate (i) associations of treatment delays with patient demographics and cancer center regions; and(ii) associations of late-stage (III and IV) cancer diagnosis with patient demographics and cancer center regions, withand without controlling for treatment delays. Results: Breast cancer patients treated in regions located further awayfrom Almaty City had higher risks of treatment delays. However, the risks of late-stage cancer diagnosis were greaterfor patients treated in Almaty City and those with treatment delays. Conclusion: The main driver of delayed treatmentis cancer center region. Residents of Almaty City, a major urban area of Kazakhstan, may have a better access to atertiary cancer center, resulting in less treatment delays. Referrals of sicker patients from neighboring regions to AlmatyCity for cancer treatment is likely to increase risks of late-stage diagnosis. New or upgraded cancer centers may reducetreatment delays, but their case-mix is likely to increase.