Factors Contributing to Delayed Diagnosis of Gynecological Cancer in Karachi, Pakistan

Abstract

Background: Survival outcomes for gynecological cancers including ovarian, cervical, endometrial, vulvar, and vaginal cancers remain poor in Pakistan, largely due to late diagnosis and treatment. This study explored the main reasons behind diagnostic delays, with particular attention to financial, social, and healthcare-related barriers, and placed these findings in context with international data. Methods: We carried out a cross-sectional survey among 250 women who had been diagnosed with gynecological cancers within the past five years at hospitals in Karachi. Participants were selected through convenience sampling and completed a structured questionnaire covering their background, awareness of cancer symptoms, healthcare access, and barriers to diagnosis. The data was collected during November 2024 to May 2025 and were analyzed using descriptive statistics, chi-square tests, and logistic regression to identify the strongest predictors of delayed diagnosis. Results: Six out of ten women reported facing delays in diagnosis. The most frequent reasons were financial difficulties (60%) and long waiting times in hospitals (55%), followed by lack of referral to specialists (32%). Although most participants (70%) had some awareness of cancer symptoms, very few (20%) had undergone screening. Women from rural areas and lower-income households experienced longer delays, often linked to limited health facilities and social stigma. Regression analysis showed that financial barriers (OR = 2.5, CI = 1.8–3.7) and waiting times (OR = 1.8, CI = 1.3–2.5) were the strongest contributors. Conclusion: The delays we observed in diagnosing gynecological cancers in Pakistan cannot be pinned on a single cause. They stem from a web of challenges, financial pressures, gaps in healthcare services, limited awareness, and the weight of cultural stigma. Addressing them will require more than just one solution. Public education must be expanded so that women and their families recognize early warning signs, while hospitals need better resources and faster referral pathways. At the same time, financial support for patients is essential, because cost alone often keeps women away from timely care. Other countries, including the UK and USA, have shown that structured referral systems can reduce delays; with adaptation to local realities, similar approaches could strengthen cancer care in Pakistan and give women a better chance at survival.