Background
Breast cancer is the most commonly diagnosed cancer among women in Nigeria and a leading cause of cancer-related morbidity and mortality, with poor outcomes largely driven by late-stage presentation.
Objectives
To describe patient, diagnostic, and treatment delays among women with breast cancer in Abuja, Nigeria, and to examine their association with stage at diagnosis across sociodemographic characteristics.
Methods
We conducted a cross-sectional study between 2024-2025 among 94 women with histologically confirmed breast cancer attending two tertiary facilities - Asokoro District Hospital and University of Abuja Teaching Hospital in Abuja, Nigeria. This study was part of a broader multi-state research initiative under the Network for Oncology Research in Sub-Saharan Africa (NORA). Data on key time intervals-patient interval (symptom recognition to first facility visit), diagnostic interval (first visit to confirmed diagnosis), treatment interval (diagnosis to treatment initiation), and total time to treatment-were collected.
Delays were categorized using WHO-established thresholds informed by the Model of Pathways to Care Framework. Hospital-based oncology clinicians and nursing staff supported participant identification while local research assistants were trained in standardized quantitative data collection procedures, contributing to capacity strengthening in cancer pathways research. Associations with stage at diagnosis were assessed using chi-square tests and multivariable logistic regression. Data was analysed using STATA MP version 18.
Results
Participants had a mean age of 48.3 ± 11.4 years, with 61.7% aged 31–50 years. The majority  were married (80.9%), had children (89.4%), and had attained tertiary education (52.1%). Rural (51.1%) and urban (48.9%) residence were nearly equally represented. Health care was predominantly financed through out-of-pocket payments (71.0%), with limited health insurance coverage (18.3%).
The median total time from symptom recognition to treatment initiation was 303 days (IQR: 148–624), with 92.7% exceeding 90 days.
The median patient interval was 150.5 days (IQR: 62–420), with 68.1% experiencing delays >90 days. The median diagnostic interval was 41 days (IQR: 26–86), with 38.9% delayed >60 days, while the median treatment interval was 17 days (IQR: 3–61), with 33.3% delayed >30 days. Late-stage disease was significantly more common among women with prolonged patient delay (>90 days) compared with those with shorter delays (90.9% vs. 56.1%; p = 0.001). Prolonged patient delay remained a strong independent predictor of late-stage diagnosis (AOR = 11.63; 95% CI: 1.94–69.79; p = 0.007), after adjusting for family history of breast cancer and income level.
Conclusions/Implications
Within the context of predominant out-of-pocket health financing, prolonged patient delay was identified as the principal driver of late-stage breast cancer diagnosis in Abuja. As part of a NORA-led, multi-state effort to evaluate breast cancer pathways to care in Nigeria, these findings underscored the importance of community engagement, frontline health-worker involvement, and local research capacity strengthening to inform context-specific strategies for earlier diagnosis. Policy efforts that integrate community awareness, strengthened referral pathways, and financial risk protection are critical to reducing patient delays and improving breast cancer outcomes in low-resource settings.