Factors related to breast cancer detection mode and time to diagnosis in Alberta, Canada: a population-based retrospective cohort study

Abstract

BackgroundUnderstanding the factors affecting the mode and timeliness of breast cancer diagnosis is important to optimizing patient experiences and outcomes. The purposes of the study were to identify factors related to the length of the diagnostic interval and assess how they vary by mode of diagnosis: screen or symptom detection.MethodsAll female residents of Alberta diagnosed with first primary breast cancer in years 2004–2010 were identified from the Alberta Cancer Registry. Data were linked to Physician Claims and screening program databases. Screen-detected patients were identified as having a screening mammogram within 6-months prior to diagnosis; remaining patients were considered symptom-detected. Separate quantile regression was conducted for each detection mode to assess the relationship between demographic/clinical and healthcare factors.ResultsOverall, 38 % of the 12,373 breast cancer cases were screen-detected compared to 47 % of the screen-eligible population. Health region of residence was strongly associated with cancer detection mode. The median diagnostic interval for screen and symptom-detected cancers was 19 and 21 days, respectively. The variation by health region, however, was large ranging from an estimated median of 4 to 37 days for screen-detected patients and from 17 to 33 days for symptom-detected patients. Cancer stage was inversely associated with the diagnostic interval for symptom-detected cancers, but not for screen-detected cancers.ConclusionSignificant variation by health region in both the percentage of women with screen-detected cancer and the length of the diagnostic interval for screen and symptom-detected breast cancers suggests there could be important differences in local breast cancer diagnostic care coordination.

Breast cancer detection method, diagnostic interval and use of specialized diagnostic assessment units across Ontario, Canada

“…Of these 19, 11 had a median diagnostic interval 24 months after a negative screening mammogram (known as interval cancers). 29 The only other Canadian evidence on the breast cancer screening detection rate comes from two recent studies in Alberta, with one reporting that 44% of all breast cancers were detected through screening from 2007 to 2010 24 and the other reporting a screening detection rate of 38% from 2004 to 2010 25 (we observed 36% in Ontario in 2011). Screening eligibility criteria differ between the two provinces, as the Alberta Breast Cancer Screening Program additionally accepts patients aged 40 to 49 years.…”

“…Our observations differed from findings in Alberta, which reported medians of 19 days for the screen-detected patients and 21 days for the symptomatic patients in the years 2004 to 2010. 25 Within Ontario, we observed significant regional variation in the diagnostic interval. The maximum difference was 2.4 weeks (17 days) between LHINs.…”

“…To the best of our knowledge, this is the first Ontario study and among the first Canadian studies describing breast cancer screening detection rates and waiting time to diagnosis in a population-based breast cancer cohort. 24,25 Previous Ontario reports have been restricted to those seen within organized breast cancer screening programs 12,26 while our study also includes the 63.8% of breast cancer patients who were diagnosed symptomatically and the 7.4% detected through opportunistic screening.…”

Breast cancer delay in Latinas: the role of cultural beliefs and acculturation

“…Yet, even in countries with free access to health care, women are still diagnosed via breast symptoms instead of screen detected and there is variance in time to diagnosis. Authors attributed differences to variation in care coordination particularly in areas with lack of medical resources and rural areas (Yuan et al, 2016). In contrast, this study showed the reasons for delays may be related to interpersonal factors between patient and provider.…”

From symptom to cancer diagnosis: Perspectives of patients and family members in Alberta, Canada

“…A number of researchers have reported associations between longer intervals and later stages of cancer at diagnosis, reduced survival, decreased quality of life post-treatment, and suboptimal patient experience [3,6]. In Alberta, analyses of administrative data spanning 2004-2011 described potentially preventable long periods from suspicion to diagnosis for breast, colorectal, and lung cancers [7][8][9][10]. In Canada and across the world there are substantial variations in the length of the diagnostic period for different cancers [4,11], and numerous studies have focused on understanding factors that may influence this timeline in order to improve health outcomes and patient experience [12].…”