Analysis of survival and recurrence vs. patient and doctor delay in treatment of breast cancer

Dennis, Clarence; Gardner, Bernard; Lim, Byung Sung

doi:10.1002/1097-0142(197503)35:3<714::aid-cncr2820350326>3.0.co;2-v

Cited by 72 publications

(54 citation statements)

References 19 publications

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“…This is in agreement with findings from pertinent studies published during the last decade (Coates et al, 1992;Afzelius et al, 1994;Burgess et al, 1998) and is further evidence of a favourable trend towards shorter delay during the last two decades when compared with earlier studies (Cameron and Hinton, 1968;Dennis et al, 1975;Fisher et al, 1977;Elwood and Moorehead, 1980;MacArthur and Smith, 1981;Dohrmann et al, 1982;Vernon et al, 1985;Neale et al, 1986). This trend might be attributable to an increasing health awareness among women due to extensive information campaigns which address breast cancer warning signs in many developed countries.…”

Section: Discussionsupporting

confidence: 90%

Patient delay and stage of diagnosis among breast cancer patients in Germany – a population based study

et al. 2002

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Early diagnosis is a tenet in oncology and should enable early treatment with the expectation of improved outcome. Extent and determinants of patient delay of diagnosis in breast cancer patients and its impact on stage of disease were examined in a population based study among female breast cancer patients in Germany. Two hundred and eighty-seven women, aged 18 to 80 years with newly diagnosed invasive symptomatic breast cancer, were interviewed with respect to the diagnostic process. Patient delay was defined as time from onset of first symptoms to first consultation of a doctor. Median patient delay was 16 days among symptomatic patients. Eighteen per cent of all breast cancer patients waited longer than 3 months before consulting a physician. Long patient delay was associated with old age, history of a benign mastopathy, obesity, and indices of health behaviour such as not knowing a gynaecologist for out-patient care and non-participation in general health screening examinations. A strong association between patient delay and stage at diagnosis was observed for poorly differentiated tumours. These results suggest that at risk groups for delaying consultation can be identified and that a substantial proportion of late stage diagnoses of poorly differentiated breast cancer cases could be avoided if all patients with breast cancer symptoms would present to a doctor within 1 month.

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Section: Discussionsupporting

confidence: 90%

Patient delay and stage of diagnosis among breast cancer patients in Germany – a population based study

et al. 2002

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“…This may also help to explain some of the apparently contradictory findings in the literature. Reports published since 1970 that have shown no significant relationship between delay and survival have generally been confined to patients with early stage (operable) disease (Alderson et al, 1971;Dennis et al, 1975;Wallgren et al, 1976;Fisher et al, 1977).…”

Section: Discussionmentioning

confidence: 99%

“…Several studies reported in the past 30 years have indicated that survival is worse among women with longer duration of symptoms (Sheridan et al, 1971;Wilkinson et al, 1979;Elwood and Moorehead, 1980;Feldman et al, 1983;Charlson, 1985;Vernon et al, 1985;Huguley et al, 1988;Machiavelli et al, 1989;Rossi et al, 1990;Neave et al, 1990;Rabinovich et al, 1993;Afzelius et al, 1994;Raabe et al, 1996). Other studies, however, have not shown that survival is affected by duration of symptoms (Dennis et al, 1975;Fisher et al, 1977;Hainsworth et al, 1993) These apparently conflicting results may possibly be explained by differences in sample characteristics (e.g. inclusion of patients with all stages of breast cancer or restriction of the sample to patients with operable disease only), by differences in the delay interval studied (e.g.…”

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confidence: 99%

The influence on survival of delay in the presentation and treatment of symptomatic breast cancer

et al. 1999

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SummaryThe aim of this study was to examine the possible influence on survival of delays prior to presentation and/or treatment among women with breast cancer. Duration of symptoms prior to hospital referral was recorded for 2964 women who presented with any stage of breast cancer to Guy's Hospital between 1975 and. Median follow-up is 12.5 years. The impact of delay (defined as having symptoms for 12 or more weeks) on survival was measured from the date of diagnosis and from the date when the patient first noticed symptoms to control for lead-time bias. Thirty-two per cent (942/2964) of patients had symptoms for 12 or more weeks before their first hospital visit and 32% (302/942) of patients with delays of 12 or more weeks had locally advanced or metastatic disease, compared with only 10% (210/2022) of those with delays of less than 12 weeks (P < 0.0001). Survival measured both from the date of diagnosis (P < 0.001) and from the onset of the patient's symptoms (P = 0.003) was worse among women with longer delays. Ten years after the onset of symptoms, survival was 52% for women with delays less than 12 weeks and 47% for those with longer delays. At 20 years the survival rates were 34% and 24% respectively. Furthermore, patients with delays of 12-26 weeks had significantly worse survival rates than those with delays of less than 12 weeks. Multivariate analyses indicated that the adverse impact of delay in presentation on survival was attributable to an association between longer delays and more advanced stage. However, within individual stages, longer delay had no adverse impact on survival. Analyses based on 'total delay' (i.e. the interval between a patient first noticing symptoms and starting treatment) yielded very similar results in terms of survival to those based on delay to first hospital visit (delay in presentation).

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“…[11][12][13][14][15][16][17] Second, after diagnosis, minority women experience delays in the initiation and completion of treatment. [18][19][20] Third, there are differences in the type of treatment received by African American and Hispanic women. [21][22][23] Fourth, African American women are more likely to receive fewer cycles of the expected treatment compared with white women.…”

mentioning

confidence: 99%

Racial/Ethnic Disparities in Time to Follow-Up after an Abnormal Mammogram

Press

Carrasquillo

Sciacca³

et al. 2008

Journal of Women's Health

140

111

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Background: Although non-Hispanic white women have an increased risk of developing breast cancer, the disease-specific survival is lower for African American and Hispanic women. Little is known about disparities in follow-up after an abnormal mammogram. The goal of this study was to investigate potential disparities in follow-up after an abnormal mammogram. Methods: A retrospective cohort study of 6722 women with an abnormal mammogram and documented follow-up from January 2000 through December 2002 was performed at an academic medical center in New York City. The outcome was the number of days between the abnormal mammogram and follow-up imaging or biopsy. Cox proportional hazards models were used to assess the effect of race/ethnicity and other potential covariates. Results: The median number of days to diagnostic follow-up after an abnormal mammogram was greater for African American (20 days) and Hispanic (21 days) women compared with non-Hispanic white (14 days) women (p Ͻ 0.001). Racial/ethnic disparities remained significant in a multivariable model controlling for age, Breast Imaging Reporting and Data System (BIRADS) category, insurance status, provider practice location, and median household income. Conclusions: After an abnormal mammogram, African American and Hispanic women had longer times to diagnostic follow-up compared with non-Hispanic white women. Future efforts will focus on identifying the barriers to follow-up so that effective interventions may be implemented.

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Analysis of survival and recurrence vs. patient and doctor delay in treatment of breast cancer

Cited by 72 publications

References 19 publications

Patient delay and stage of diagnosis among breast cancer patients in Germany – a population based study

Patient delay and stage of diagnosis among breast cancer patients in Germany – a population based study

The influence on survival of delay in the presentation and treatment of symptomatic breast cancer

Racial/Ethnic Disparities in Time to Follow-Up after an Abnormal Mammogram

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