Factors predicting delayed presentation of symptomatic breast cancer: a systematic review

Ramirez, Amanda-Jane; Westcombe, AM; Burgess, Caroline; Sutton, Stephen; Littlejohns, Peter; Richards, MA

doi:10.1016/s0140-6736(99)02142-x

Cited by 422 publications

(464 citation statements)

References 23 publications

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“…Similar findings have been reported from various countries (Polednak, 1986;Yancik et al, 1989;Coates et al, 1992;Afzelius et al, 1994;Fowble et al, 1994;Ramirez et al, 1999). Several explanations why patient delay is more often found among older women have been suggested.…”

Section: Discussionsupporting

confidence: 87%

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: 87%

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

et al. 2002

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“…Many studies linked advanced ages, i.e. seniors, with late presentation (Facione, 1993;Ramirez et al, 1999;Stapleton et al, 2011). This is exactly at odd to our findings that did not correlate both issues.…”

Section: Discussionsupporting

confidence: 66%

“…Marital status stands out as a highly debatable issue. The non-significant association resulted matches Innos et al (2013) and Ramirez et al (1999) DOI:http://dx.doi.org/10.7314/APJCP.2016.17.4.2105 between marriage and late presentation, contradicts what other studies have reached (Thongsuksai et al, 2000;Ali et al, 2008;Kumari and Goonewardena, 2001). Our conclusions which did not associate both education and occupation with presentation category are in keeping with many reports (Norsa'adah et al, 2011;Cheng et al, 2015).…”

Section: Discussioncontrasting

confidence: 59%

Factors Delaying Presentation of Sudanese Breast Cancer Patients: an Analysis Using Andersen's Model

Salih

Alfaki²,

Alam-Elhuda³

et al. 2016

Asian Pacific Journal of Cancer Prevention

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Purpose: A multicenter, observational, cross-sectional study was conducted to assess factors delaying presentation of breast cancer cases. Materials and Methods: Data were collected from a pair of highly specialized referral centers, both located in the center of the Sudanese capital, Khartoum. For a total of 153 eligible respondents, durations of delay, clinicodemographic factors and reasons of referral were collected from our respondents through self-administered questionnaires. Logistic regression analysis and ANOVA were used to test the relation between periods of delay and different factors. Odd ratios (OR's) and their correspondent Confidence intervals (95% CI's). Delay periods were studied with Andersen's model. Results: The average duration of delay in our study was 11.9 (±11.2) months. Only a quarter of our patients presented early within the first 3 months after onset of their symptoms. About 47.7% arrived later during the course of the first year, while it took beyond that for the last 27% to come. A prior diagnosis of BC was the only predictor of early presentation (for 3-12 months OR=9.6 (p<0.00), 95% CI 9.55-9.75; for >12 months OR=9.3 (p<0.00), 95% CI 9.33-9.33). Out of the 12 different reasons for delay given by our respondents, none showed a significant difference between patients presenting early or late. Financial incapacity (17.5%), ignorance about BC (14.3), and misinterpreting symptoms (12.7%) were the top three whys of delay. Conclusions: Our findings support existence of a non-uniform pattern of delay among Sudanese BC patients. Changing currently adopted awareness elevating strategies into much more inclusive approaches is strongly recommended.

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“…Symptomatic breast cancer, often associated with a diagnostic delay7, is usually associated with more aggressive tumour characteristics8 and therefore a higher mortality rate than screening‐detected breast cancer7. Indeed, in countries where screening programmes do not exist or do not function properly, breast cancer prognosis at the time of diagnosis is generally poorer9 than in countries where screening programmes have been established.…”

Section: Introductionmentioning

confidence: 99%

St Gallen molecular subtypes in screening-detected and symptomatic breast cancer in a prospective cohort with long-term follow-up

Falck

Röme

Fernö

et al. 2016

British Journal of Surgery

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BackgroundDiagnosis by screening mammography is considered an independent positive prognostic factor, although the data are not fully in agreement. The aim of the study was to explore whether the mode of detection (screening‐detected versus symptomatic) adds prognostic information to the St Gallen molecular subtypes of primary breast cancer, in terms of 10‐year cumulative breast cancer mortality (BCM).MethodsA prospective cohort of patients with primary breast cancer, who had regularly been invited to screening mammography, were included. Tissue microarrays were constructed from primary tumours and lymph node metastases, and evaluated by two independent pathologists. Primary tumours and lymph node metastases were classified into St Gallen molecular subtypes. Cause of death was retrieved from the Central Statistics Office.ResultsA total of 434 patients with primary breast cancer were included in the study. Some 370 primary tumours and 111 lymph node metastases were classified into St Gallen molecular subtypes. The luminal A‐like subtype was more common among the screening‐detected primary tumours (P = 0·035) and corresponding lymph node metastases (P = 0·114) than among symptomatic cancers. Patients with screening‐detected tumours had a lower BCM (P = 0·017), and for those diagnosed with luminal A‐like tumours the 10‐year cumulative BCM was 3 per cent. For patients with luminal A‐like lymph node metastases, there was no BCM. In a stepwise multivariable analysis, the prognostic information yielded by screening detection was hampered by stage and tumour biology.ConclusionThe prognosis was excellent for patients within the screening programme who were diagnosed with a luminal A‐like primary tumour and/or lymph node metastases. Stage, molecular pathology and mode of detection help to define patients at low risk of death from breast cancer.

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Factors predicting delayed presentation of symptomatic breast cancer: a systematic review

Cited by 422 publications

References 23 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

Factors Delaying Presentation of Sudanese Breast Cancer Patients: an Analysis Using Andersen's Model

St Gallen molecular subtypes in screening-detected and symptomatic breast cancer in a prospective cohort with long-term follow-up

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