The delay in diagnosis and treatment of breast cancer remains a serious problem. Several psychological and behavioural patient attributes strongly determine both patient-related delay time and system-related delay time, but their strength is different in particular countries.

In breast cancer, early detection as well as new developments in therapeutic options has resulted in less patients presenting with metastatic disease. However, about one-third of women with early stage breast cancer will eventually develop metastatic disease. Furthermore, approximately 20-30% of patients with breast cancer have tumors that overexpress human epidermal growth factor receptor (HER-2), which is associated with an aggressive tumor phenotype and poor prognosis. The identification of the HER-2 protein led to the development of highly effective therapeutics directed at this receptor. Trastuzumab, a recombinant, humanized, monoclonal antibody that binds to the extracellular domain of the HER-2 protein, has shown significant clinical benefit in metastatic and early-stage HER-2-positive breast cancer. Since the cancer recurs after adjuvant therapy in some women, and metastatic breast cancer eventually develops resistance to trastuzumab, there is a need for alternative treatment modalities to block HER-2 signaling. One of these treatment options is lapatinib, an orally active small molecule that inhibits the tyrosine kinases of HER-2 and the epidermal growth factor receptor type 1 (EGFR). In this consensus statement current treatment options in metastatic and locally advanced disease are discussed with a special focus on lapatinib.

9046 Background: Reducing diagnostic delays may improve treatment outcomes in BC. We investigated in various countries patient-related factors influencing time to seeking medical advice for signs of BC. Methods: A total of 4,816 female BC patients from 10 countries were surveyed using a uniform questionnaire translated into local languages. Time between first patient-detected signs of BC and AMV was measured using categorized time scales. Out of 14 original items on a multiple scale measuring BC-related attitudes and behaviors, 5 factors were extracted and used for further analysis: distrust in medical system and success of therapy, disregard of signs, fear of BC, practicing regular breast self-examination and support from friends and family. Results: In the subset of 2,870 patients with self-detected BC who provided complete answers to relevant variables, the mean time to AMV varied in particular countries from 3.4 to 6.2 weeks (grand mean of 4.7 weeks), with 39% of cases with a delay of >4 weeks. Overall, patient attributes that significantly influenced time to AMV were: distrust (p<1E-36), disregard (p=1.26E-30), fear (p=2.65E-16), self-examination (p=1.31E-21), place of living (p=3.5E-3) and education (p=2.73E-3). Multilevel analysis indicated that significant differences among particular countries were only due to slopes of distrust and disregard included in general regression model. The model enhanced with the two abovementioned random effects provided significant improvement in predicting time to AMV. Re-estimation of the model based solely on data from individual countries produced 10 significant equations with varied coefficients for distrust and disregard (see table). Conclusions: Patient-related factors contribute considerably to delay in the diagnosis of BC. Differences between particular countries call for country-specific approaches. [Table: see text]

Background. We earlier reported patient-related factors influencing the delay in first medical advice for signs of BC in selected countries (J Clin Oncol 2012;30[15S]:578s). The present analysis, which includes additional countries, addresses the factors influencing time from first symptoms of BC to initiation of treatment (Total Delay Time; TDT). Methods. A total of 6,588 female BC patients from 11 countries were surveyed using a uniform questionnaire translated into local languages. TDT was determined using 8 individual scales, including one pertaining to patient delay and 7 related to subsequent steps in a typical diagnostic process. Regression models were constructed using 18 variables concerning diverse contextual and personal patient characteristics. Due to expected differences in the relevant sets of predictors, time between first symptoms and first medical visit (Patient Delay Time; PDT) and time between first medical visit and start of therapy (System Delay Time; SDT) were modeled separately, with multilevel regression. Results. Mean TDT varied in individual countries from 11.5 to 29.4 weeks (grand mean of 14.3 weeks; see table), with 43% of cases with a delay of &gt;12 weeks. Multilevel regression equation indicated that factors significantly correlated with longer PDT were distrust in the medical system and ignoring disease. Patients with fear of the disease, stronger self-examination habits, at least secondary education, being employed, reporting more support from friends and family, and living in cities of &gt;100,000 inhabitants had shorter PDT. Predictors of shorter SDT included being diagnosed by an oncologist vs. other physician, having at least secondary education, being older than 60 years, having a history of cancer in female relatives and having breast lump vs. other BC symptoms. Indicators of longer SDT were PDT &gt;4 weeks, more than one BC symptom detected by patient, distrust in the medical system, disregard of BC signs, less support from friends and family, and having first medical examination in a public vs. private medical center. Individual countries differed significantly with regard to intercept of the multilevel models and slopes of regression coefficients for selected psychological and behavioral attributes. Conclusions. An extensive set of variables potentially impacting delay times, mainly related to psychological and behavioral patient attributes, was examined. Several of them strongly determined both PDT and SDT, but their strength differed between individual countries. Both models (for PDT and SDT), although statistically significant, accounted for approximately 20% of variance in time; therefore other variables, e.g. related to the differences in national healthcare systems (not addressed in this study) might have a stronger impact on delays in the initiation of BC therapy and warrant further analyses. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-02-02.