Summary This study aimed to examine the extent and determinants of patient and general practitioner delay in the presentation of breast cancer. One hundred and eighty-five cancer patients attending a breast unit were interviewed 2 months after diagnosis. The main outcome measures were patient delay in presentation to the general practitioner and non-referral by the general practitioner to hospital after the patient's first visit. Nineteen per cent of patients delayed 2 12 weeks. Patient delay was related to clinical tumour size > 4 cm (P = 0.0002) and with a higher incidence of locally advanced and metastatic disease (P = 0.01). A number of factors predicted patient delay: initial breast symptom(s) that did not include a lump (OR 4.5, P= 0.003), not disclosing discovery of the breast symptom immediately to someone else (OR 6.0, P < 0.001), seeking help only after being prompted by others (OR 4.4, P = 0.007) and presenting to the general practitioner with a nonbreast problem (OR 3.5, P = 0.03). Eighty-three per cent of patients were referred to hospital directly after their first general practitioner visit. Presenting to the GP with a breast symptom that did not include a lump independently predicted general practitioner delay (OR 3.6, P = 0.002). In view of the increasing evidence that delay adversely affects survival, a large multicentre study is now warranted to confirm these findings that may have implications for public and medical education.Keywords: patient delay; GP delay; breast cancer; psychological response; type of symptom For women who present with symptomatic breast cancer there is, by definition, an interval between first detection of symptoms (either by the woman herself or by another) and the time of diagnosis and treatment. Prolonged delays, usually defined arbitrarily as intervals greater than 12 weeks, occurring during this period have been shown to be associated with increased tumour size (Fisher et al, 1977;Pilipshen et al, 1984; GIVIO, 1986;Neave et al, 1990;Rossi et al, 1990) and more advanced stage of disease (Elwood and Moorehead, 1980;Gould-Martin et al, 1982;Robinson et al, 1984; GIVIO, 1986;Machiavelli et al, 1989;Rossi et al, 1990) and with poor long-term survival (Neave et al, 1990;Afzelius et al, 1994).Given this relationship between delay, stage and survival, it is important to assess in detail the different phases of delay between first detection of a symptom and treatment being commenced. For each of these phases, factors need to be identified that are associated with prolonged delays, so that effective strategies can be planned to reduce the overall interval between first symptom and treatment.The phases of delay can be considered as follows:1. Patient delay. The interval between first detection of a symptom and first presentation to a health professional, usually a general practitioner (GP). 2. GP delay. The interval between first presentation to a GP and onward referral to a hospital. This study examines patient and GP delay in a prospective cohort of women presenting to the ...
