Barriers and Explanatory Mechanisms of Delays in the Patient and Diagnosis Intervals of Care for Breast Cancer in Mexico

Unger‐Saldaña, Karla; Ventosa‐Santaulària, Daniel; Miranda, Alfonso; Verduzco-Bustos, Guillermo

doi:10.1634/theoncologist.2017-0431

Cited by 38 publications

(66 citation statements)

References 44 publications

(60 reference statements)

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“…The number of HCP used by patients before admission to the HNL was significantly lower, compared to those used by patients before admission to the FAP. In agreement with present results, a recent Mexican study associated diagnostic delay with increased number of HCP, used before admission to a specialized health care centre (Unger-Saldaña et al, 2018). According to the INCA and the Ministry of Health, women who experience breast cancer symptoms should visit a primary HCP for clinical breast examination (Migowski et al, 2018).…”

Section: Discussionsupporting

confidence: 88%

Availability of Diagnostic Services and their Impact on Patient Flow in Two Brazilian Referral Centres of Breast Cancer Treatment

Santos

Andrade

Oliveira

et al. 2020

Asian Pac J Cancer Prev

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Background: System delay (SD) is a leading cause of advanced stage of disease and poor prognosis among Brazilian breast cancer patients. Methods: Cox regression and Kaplan-Meier analysis were used to identify variables that contributed to SD among 128 breast cancer patients. Time intervals between first medical consultation and treatment initiation were compared among patients of two referral centres: Patients of a referral centre with outsourced (FAP), respectively, integrated (HNL) diagnostic services. Results: Women who used a specialized private clinic at the beginning of patient flow had an 2.32 fold increased chance (95% CI: 1.17-4.60; p = 0.016) of hospital admission within 90 days after first medical consultation, compared to women who used a public health care provider (HCP). Of 73 and 34 patients of the FAP hospital and the HNL, respectively, 10 (13.7%) and 11 (32.5%) used one HCP prior to hospital admission (p = 0.000). The median time between first medical consultation and treatment initiation was 150 days. The median time between first medical consultation and hospital admission was 136.0 and 52.0 days for patients of the FAP hospital, respectively the HNL (p < 0.050). The median time between first medical consultation and diagnostic mammography was 36.5 and 23.0 days for patients from the FAP hospital and the HNL (p < 0.050). Conclusions: Usage of public diagnostic services was associated with increased SD, whereas the usage of private diagnostic services diminished it. The usage of a lower number of HCPs accelerated patient flow.

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Section: Discussionsupporting

confidence: 88%

Availability of Diagnostic Services and their Impact on Patient Flow in Two Brazilian Referral Centres of Breast Cancer Treatment

Santos

Andrade

Oliveira

et al. 2020

Asian Pac J Cancer Prev

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“…Diagnosis interval was calculated from the date of first symptom/mammogram to the date of histopathological diagnosis, treatment interval from the date of histopathological diagnosis to the treatment starting date, and total interval from the date of first symptom/mammogram to the treatment starting date. 22…”

Section: Methodsmentioning

confidence: 99%

Comparison of characteristics in Mexican women with breast cancer according to healthcare coverage

Martínez-Cannon

Zertuche-Maldonado

Pacheco

et al. 2020

Womens Health (Lond Engl)

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Objective: To compare the sociodemographic, diagnostic, clinical, and treatment-related characteristics and outcomes of patients with breast cancer in two hospitals in Mexico according to type of healthcare coverage. Methods: A retrospective cohort study of women with breast cancer according to public or private healthcare coverage in two hospitals was done. Patients were treated by the same group of physicians and healthcare infrastructure. Groups were compared using the chi-square test for categorical variables, Mann–Whitney U-test and Student’s t-test for quantitative variables, and Kaplan–Meier estimator and log-rank test for time dependent outcomes (including recurrence-free and overall survival). A value of p < 0.05 was considered statistically significant. Results: A total of 282 women were included. Mean age at diagnosis was 52 years. Women with public healthcare coverage were diagnosed more frequently with self-detected tumors (82.8% vs 47.9%, p < 0.001) and advanced clinical stage (III and IV) (31.1% vs 17.8%, p = 0.014). More women with public healthcare insurance underwent initial systemic treatment (41.1% vs 17.8%, p < 0.001) and mastectomy (70.1% vs 54.9%, p = 0.020), and received more chemotherapy (79.4% vs 43.8%, p < 0.001) and adjuvant radiotherapy (68.9% vs 53.4%, p = 0.017). Overall, no differences were found in survival outcomes according to healthcare coverage. Trends suggesting worse recurrence-free and overall survival were observed in patients with public coverage at 3 years follow-up in stage III (85.7% vs 67.3% and 100% vs 84.6%, respectively) and triple negative disease (83.3% vs 74.5% and 100% vs 74.1%, respectively). Conclusion: Strategies to promote preventive medicine, diagnostic mammograms, and prompt diagnosis of breast cancer in Mexican women with public health coverage are needed. Access to the main treatment modalities by Seguro Popular and good quality care by an experienced group of physicians likely explains the similar outcomes between patients with private and public healthcare coverage. However, trends suggesting worse survival for patients with public medical coverage with stage III and triple-negative disease should encourage close follow-up.

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“…22 The inclusion and order of variables in our path analysis was based on previous work—a conceptual model that resulted from a qualitative study of help-seeking behavior of women with BC, and a path diagram that resulted from a quantitative study on factors associated with BC health system delay. 23,24 Each equation was estimated by taking into account the nature of the dependent variable: logistic regression for binary responses and linear multivariable regressions for continuous responses. The results of the path analysis are represented in a path diagram in which straight unidirectional arrows represent causal relationships (Fig 3).…”

Section: Methodsmentioning

confidence: 99%

Breast Cancer Diagnostic Delays Among Young Mexican Women Are Associated With a Lack of Suspicion by Health Care Providers at First Presentation

Unger‐Saldaña

Fitch-Picos

Villarreal‐Garza

2019

JGO

Self Cite

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PURPOSE There is insufficient evidence in the literature regarding the association between young age and diagnostic delay of breast cancer (BC). This study aimed to determine whether young age increases the risk of diagnostic delays among patients with BC and also to identify the mechanisms through which young age affects diagnostic delay. PATIENTS AND METHODS This was a cross-sectional study of 592 patients with symptomatic BC treated at two of the largest public cancer hospitals in Mexico City available for the uninsured and those covered by Seguro Popular. A validated questionnaire was administered via face-to-face interviews with the patients, and their medical files were reviewed. Path analyses, using multivariable logistic regression models, were conducted to assess the relationship between age and diagnostic delay, as well as the role of potential confounders. RESULTS Younger participants (40 years of age or younger) had significantly longer diagnostic intervals and presented with more advanced cancer stage than did their older counterparts. Younger participants more often sought initial health care in private services led by gynecologists, more frequently experienced a lack of cancer suspicion by the first physician they consulted, used a higher number of different health services, and had more medical consultations before arrival to a cancer care center. Younger age was significantly associated with longer diagnostic delays after controlling for education, occupation, lack of health insurance, history of benign breast conditions, type of first health service used, specialty of the first physician consulted, first symptom presented, and benign interpretation of the first breast image study. CONCLUSION Young age increased the risk of diagnostic delays, which seems to be a result of an increased risk of lack of cancer suspicion at the first health care service consulted.

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Barriers and Explanatory Mechanisms of Delays in the Patient and Diagnosis Intervals of Care for Breast Cancer in Mexico

Cited by 38 publications

References 44 publications

Availability of Diagnostic Services and their Impact on Patient Flow in Two Brazilian Referral Centres of Breast Cancer Treatment

Availability of Diagnostic Services and their Impact on Patient Flow in Two Brazilian Referral Centres of Breast Cancer Treatment

Comparison of characteristics in Mexican women with breast cancer according to healthcare coverage

Breast Cancer Diagnostic Delays Among Young Mexican Women Are Associated With a Lack of Suspicion by Health Care Providers at First Presentation

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