Clinical and prognostic factors associated with diagnostic wait times by breast cancer detection method

Abstract

IntroductionAlthough prognostic differences between screen-detected, interval and symptomatic breast cancers are known, factors associated with wait times to diagnosis among these three groups have not been studied.MethodsOf the 16,373 invasive breast cancers diagnosed between January 1, 1995 and December 31, 2003 in a cohort of Ontario women aged 50 to 69, a random sample (N = 2,615) were selected for chart abstraction. Eligible women were classified according to detection method; screen-detected (n = 1181), interval (n = 319) or symptomatic (n = 406). Diagnostic wait time was calculated from the initial imaging or biopsy to breast cancer diagnosis. Logistic regression analysis examined associations between diagnostic wait times dichotomized as greater or less than the median and demographic, clinical and prognostic factors separately for each detection cohort.ResultsWomen who underwent an open biopsy had significantly longer than median wait times to diagnosis, compared to women who underwent a fine needle aspiration or core biopsy; (screen-detected OR = 2.76, 95% CI = 2.14-3.56; interval OR = 2.56, 95% CI = 1.50-4.35; symptomatic OR = 5.56, 95% CI = 3.33-9.30). Additionally, screen-detected breast cancers diagnosed with stage II and symptomatic cancers diagnosed at stage III or IV had significantly shorter diagnostic wait times compared to those diagnosed at stage 1 (OR = 0.66 95% CI = 0.50-0.87 and OR = 0.46, 95% CI = 0.25-0.85 respectively).ConclusionsOur study is consistent with expedited diagnostic work-up for breast cancers with more advanced prognostic features. Furthermore, women who had an open surgical biopsy had a greater than the median diagnostic wait time, irrespective of detection method.

The Impact of Rurality and Disadvantage on the Diagnostic Interval for Breast Cancer in a Large Population-Based Study of 3202 Women in Queensland, Australia

“…Our results are similar to that of several large USA and Canadian studies reporting median times between 12 and 16 days with approximately 80% of women diagnosed within 30 days [63,64,65,66]. BreastScreen Australia recommends women with a screen-detected abnormality should be assessed within 28 days, with their most recent evaluation report indicating around 20% of women were not fully assessed within that time frame [67], similar to our study results.…”

Timely follow‐up of positive cancer screening results: A systematic review and recommendations from the PROSPR Consortium

“…The method of result notification (with telephone and letter notification associated with longer delays than in‐person notification), as well as the use of navigators, rapid diagnostic units, and organized screening programs, influence the timeliness of follow‐up . Procedures that reduce the number of interfaces involved (such as use of core needle biopsy rather than open biopsy for abnormal mammograms) may reduce the time to biopsy …”

“…33,127,131 Procedures that reduce the number of interfaces involved (such as use of core needle biopsy rather than open biopsy for abnormal mammograms) may reduce the time to biopsy. 132 Thus, overcoming barriers to timely follow-up likely will require multilevel interventions to mitigate multiple barriers, 133 but evidence is limited regarding effective interventions. 2,3 A recent systematic review of interventions to improve follow-up of positive FIT found only limited evidence that supported the use of patient navigators or giving providers reminders or performance data.…”

Are disparities of waiting times for breast cancer care related to socio‐economic factors? A regional population‐based study (France)

“…Accordingly, we found longer WT, due to diagnostic WT, associated with not being taxable. On the contrary, a higher income quintile was also associated with longer treatment WT, but it was not a predictor of diagnostic WT, whatever the mode of detection . No difference in treatment WT or in overall WT by deprivation quintile was found in two studies in the UK, nor in the study reported by Gorey et al in Ontario …”

“…Because of missing data, only 653 women were analyzed in the multivariate models. The three median WTs of these 653 [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] women (44 days (IQR 5 33-60) for overall WT, 9 days (IQR 5 3-20) for diagnostic WT and 31 days (IQR 5 23-42) for treatment WT) did not differ from those of the 973 women initially included in our descriptive analyses. The lack of social support was strongly related to WTs but was missing for 81 women.…”