ASSOCIATION BETWEEN HYPOTHYROIDISM AND DELAYED DIAGNOSIS OF BREAST CANCER IN WOMEN FROM LOW-RESOURCE COMMUNITIES: A CROSS-SECTIONAL STUDY
DOI:
https://doi.org/10.71000/w8n9q597Keywords:
Breast Neoplasms, Diagnostic Delay, Hypothyroidism, , Low-Income Population, Pakistan, Risk Factors, Socioeconomic FactorsAbstract
Background: Breast cancer is a leading cause of cancer-related mortality among women worldwide, with delayed diagnosis significantly reducing survival. Hypothyroidism, a common endocrine disorder in women, may complicate breast cancer recognition by producing overlapping symptoms that obscure early detection, particularly in low-resource settings.
Objective: To evaluate whether hypothyroidism contributes to diagnostic delays and advanced disease presentation in breast cancer among underserved women.
Methods: A cross-sectional study was conducted over six months in tertiary care hospitals of Lahore, Pakistan, including 180 women with histologically confirmed breast cancer. Sociodemographic, clinical, and diagnostic timeline data were collected through structured questionnaires and medical record review. Thyroid status was determined using serum thyroid-stimulating hormone and free thyroxine levels. Diagnostic delay was defined as an interval greater than 12 weeks between initial symptom recognition and histological confirmation. Data were analyzed using descriptive statistics, chi-square tests, independent sample t-tests, and multivariate logistic regression, with a significance threshold of p < 0.05.
Results: The mean age of participants was 47.8 ± 7.6 years, and 21.7% were diagnosed with hypothyroidism. Overall, 45.0% experienced diagnostic delays. Hypothyroid women exhibited a slightly higher proportion of delayed diagnoses (35.7% vs. 44.8% in euthyroid women) and advanced-stage disease (56.4% vs. 49.0%), though these differences were not statistically significant after adjustment (adjusted OR 1.14, 95% CI 0.84–1.58, p = 0.27). Low education and monthly income below 20,000 PKR emerged as significant predictors of delayed diagnosis (p < 0.05).
Conclusion: Hypothyroidism was not independently associated with delayed breast cancer diagnosis, while socioeconomic factors exerted a stronger influence. Targeted education and improved access to diagnostic services remain critical for early detection in low-resource communities.
Keywords: Breast Neoplasms, Diagnostic Delay, Hypothyroidism, Low-Income Population, Pakistan, Risk Factors, Socioeconomic Factors.
References
Majeed I, Ammanuallah R, Anwar AW, Rafque HM, Imran FJEMHJ. Diagnostic and treatment delays in breast cancer in association with multiple factors in Pakistan. 2021;27(1):23-32.
Basheer S, Brigetti L, Iqbal S, Sadia HJIJoTiHS. Breast Cancer is Still on The Rise Among Women in Pakistan: Reasons for Delayed Diagnosis. 2023;1(1):5-10.
Chughtai A, Hussain S, Malik GJs. INVITED LECTURES (I).1:12.
Shaheen N, Jan MRU, Riaz S, Khan MSJJoC, Specialties A. Late morbidity among survivors of childhood cancers; experience at tertiary care cancer hospital. 2020;6(2):e351.
Ikram A, Pervez S, Khadim MT, Sohaib M, Uddin H, Badar F, et al. National cancer registry of Pakistan: first comprehensive report of cancer statistics 2015-2019. 2023;33(6):625-32.
Kurkuri A, Yeole BBJAPJoCP. Social inequalities in cancer with special reference to South Asian countries. 2006;7(1):36.
Elhawary NA, Ekram SN, Sembawa HA, Tashkandi E, Bannani S, Azher ZA, et al. Descriptive epidemiology of female breast cancer around the world: incidence, mortality, and sociodemographic risks and disparities. 2025:1-15.
Omotoso O, Teibo JO, Atiba FA, Oladimeji T, Paimo OK, Ataya FS, et al. Addressing cancer care inequities in sub-Saharan Africa: current challenges and proposed solutions. 2023;22(1):189.
Pervez S, Jabbar AA, Haider G, Qureshi MA, Ashraf S, Lateef F, et al. Karachi Cancer Registry (KCR): consolidated data of 5 years 2017-2021. 2023;1:01.
Pourshams A, Sepanlou SG, Ikuta KS, Bisignano C, Safiri S, Roshandel G, et al. The global, regional, and national burden of pancreatic cancer and its attributable risk factors in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. 2019;4(12):934-47.
Youn HJ, Han WJAPjocpA. A review of the epidemiology of breast cancer in Asia: focus on risk factors. 2020;21(4):867.
Al-Worafi YM. Cancer: Risk Factors in Developing Countries. Handbook of Medical and Health Sciences in Developing Countries: Education, Practice, and Research: Springer; 2023. p. 1-23.
Abdullah M, Niazi N, Danaei G, Bump J, Rebbeck TR, Hashimi I, et al. Cancer Incidence in Kabul, Afghanistan: The First Report From the Population‐Based Cancer Registry. 2025;14(8):e70844.
Harrison J, Sullivan F, Keenan K, Kulu HJBph. All-cancer incidence and mortality in Pakistanis, Bangladeshis, and their descendants in England and Wales. 2024;24(1):3352.
Liew SZH, Ng KW, Ishak NDB, Lee SY, Zhang Z, Chiang J, et al. Geographical, ethnic, and genetic differences in pancreatic cancer predisposition. 2023;12(3):27-.
Shobeiri MJ, Razzaghpour NJPJoMS. Study of demographic and risk factors in endometrial cancer at Al-Zahra hospital from 2007-2009. 2012;28(1).
ZENDEHDEL K, BASU P, SHAHEEN R, SLAMA S, MUKHERJI D, AL HOMOUD S, et al. Early detection of cancer: An evolving necessity in the Eastern Mediterranean Region. 2022;45.
Siegel KR, Patel SA, Ali MKJBmb. Non-communicable diseases in South Asia: contemporary perspectives. 2014;111(1):31-44.
Shayan NA, Rahimi A, Özcebe HJCR. Cancer prevalence, incidence, and mortality rates in Afghanistan in 2020: A review study. 2023;6(9):e1873.
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. 2021;71(3):209-49.
Zhang R, Mei Z, Feng S, Chen ZJFiO. Global, regional, and national burden of Pediatric and adolescent thyroid cancer from 1990 to 2021: a statistical analysis of prevalence, incidence, and DALYs. 2025;15:1630648.
Manzoor Y, Dilshad M, Hassan SG, Hasan M, Nasir M, Tariq T, et al. Blueprinting in coherence to diagnostic momentum: On account of cancer detection in Bahawalpur Community. 2022;3(1):64-79.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Muniba Javed, Muskan Bhutto, Rehana Shaheen, Ahmar Iftikhar, Musawir Hussain, Javeria Naz, Yusra Riaz (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
