Late-stage breast cancer diagnosis in Eastern Morocco: the role of sociodemographic, healthcare access, and tumor-related factors
Keywords:
Breast cancer; Late-stage diagnosis; Symptom-to-diagnosis interval; Healthcare access; Morocco.Abstract
Background and aim of the work: Breast cancer (BC) is the most common cancer among women, and unequal access to early diagnosis contributes to prognostic disparities. We aimed to identify factors associated with late-stage BC diagnosis among women in Taza Province, Morocco. Research design and Methods: This retrospective analytical study included 212 women with histologically confirmed BC diagnosed at the Reproductive Health Reference Centre of Taza during 2020-2025 and subsequently managed at Hassan II University Hospital in Fez. Stage was classified as early (I-II) or late (III-IV). Three logistic regression models were developed: pre-diagnostic, tumor-related, and combined. Results: Overall, 121 women (57.1%) were diagnosed at a late stage. In the pre-diagnostic model, being divorced (aOR=7.84; 95% CI 1.53-40.08), rural residence (aOR=2.17; 95% CI 1.13-4.15), AMO Tadamon/RAMED coverage (aOR=2.78; 95% CI 1.32-5.87), and a symptom-to-diagnosis interval >6 months (aOR=2.67; 95% CI 1.41-5.05) were associated with late-stage diagnosis; age ≥60 years was inversely associated (aOR=0.37; 95% CI 0.17-0.81). In the tumor-related model, SBR grade III was associated with late-stage diagnosis (aOR=4.60; 95% CI 1.04-20.39). In the exploratory combined model, the triple-negative subtype was also associated (aOR=6.20; 95% CI 1.52-25.25). Conclusions: Late-stage diagnosis in Taza was mainly associated with diagnostic-pathway constraints and social vulnerability, with an additional contribution from aggressive tumor biology. Shorter diagnostic intervals and stronger Taza-Fez coordination are priorities.
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