Influence of delay to diagnosis on prognostic indicators of screen‐detected breast carcinoma

Abstract

BACKGROUND Although delay to diagnosis after a breast screening abnormality causes anxiety, its effect on prognosis is unknown. METHODS Using pooled data from five Canadian organized breast cancer screening programs, the authors used unconditional logistic regression to evaluate the effect of delay to diagnosis on prognostic indicators among 4465 women with invasive breast carcinoma diagnosed in the ipsilateral breast within 3 years of an abnormal screen performed during 1990–1996. RESULTS Women with high‐suspicion screens (n = 1569) compared with those without (n = 2896) were more promptly investigated (median days from screen to diagnosis, 31 vs. 47; P ≤ 0.0001), had larger tumors (79.4% vs. 55.9% > 10 mm; P ≤ 0.0001), and were more likely to be lymph node positive (33.9% vs. 17.3%; P ≤ 0.0001). For delays beyond > 12 to ≤ 20 weeks, a linear trend of increased tumor size and lymph node positivity began to emerge. Controlling for suspicion, the authors found that odds ratios for tumor size greater than 10 mm were 0.9 (95% CI, 0.66–1.17), 1.2 (95% confidence interval [CI], 0.88–1.56), 1.5 (95% CI, 1.05–2.16), and 2.1 (95% CI, 1.15–3.86) for delays of > 12 to ≤ 20, > 20 to ≤ 52, > 52 to ≤ 104, and > 104 ≤ 156 weeks, respectively (ptrend ≤ 0.0001), compared with delays of > 4 to ≤ 12 weeks. Similarly, odds ratios for lymph node metastasis were 1.0 (95% CI, 0.67–1.42), 1.2 (95% CI, 0.84–1.69), 2.2 (95% CI, 1.48–3.15), and 3.2 (95% CI, 1.84–5.55) for the same time intervals (ptrend = 0.0033). CONCLUSIONS The authors' findings suggest that delays to diagnosis of asymptomatic breast carcinoma of 6 to 12 months are associated with progression of breast carcinoma as measured by increasing risk of lymph node metastases and larger tumor size. A policy of early recall rather than biopsy for low suspicion mammographic abnormalities may introduce delays of this magnitude. The tendency to more expediently investigate women with high‐suspicion, worse prognosis screens (suspicion bias) obscures whether delays shorter than 20 weeks also worsen prognostic indicators. Suspicion bias should be considered when interpreting the effect of delay on prognosis. Cancer 2002;94:2143–50. © 2002 American Cancer Society. DOI 10.1002/cncr.10453

Mammography screening in the Netherlands: delay in the diagnosis of breast cancer after breast cancer screening

“…The tumour stages of breast cancers with a delayed diagnosis in our study were more favourable compared with cancers diagnosed within 3 months of a positive screen. In contrast, a Canadian study showed that screen-detected breast cancers diagnosed between 20 and 52 weeks after mammographic screening more often had a larger tumour size or lymph node metastases compared with breast cancers diagnosed within 4 -12 weeks of an abnormal screen (Olivotto et al, 2002). Our findings may be explained by diagnostic suspicion bias: the workup may have been more aggressive for mammographic features highly suggestive of cancer.…”

Sociodemographic Factors Associated with Delays in Breast Cancer

“…In industrialized countries such as Canada, Norway, Sweden and the United Kingdom, only between 8% and 22% of patients are diagnosed with locally advanced breast cancer [16].…”

Características clínico-patológicas e estadiamento ao diagnóstico de pacientes com câncer de mama em um centro de saúde do interior de Minas Gerais

“…Diferenças de sobrevida podem ser explicadas pelos estágios mais avançados ao diagnóstico nos países em desenvolvimento 5 . Estudos têm demonstrado, também, que fatores como a falta de acesso aos serviços de saúde, os atrasos na investigação de lesões mamárias suspeitas e na efetivação do tratamento da doença têm contribuído para o diagnóstico e tratamento tardios e, consequentemente, para a elevada mortalidade por câncer de mama [6][7][8][9] . O prognóstico das pacientes está intimamente relacionado ao estadio em que os tumores são diagnosticados.…”