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

Abstract

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 outpatient 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.

Symptoms and referral of women with epithelial ovarian tumors

“…The patient's delay was longer in this and in the study of Kjellgren and Solheim [9] compared to the findings of Flam et al [10]. In several studies on breast cancer, long patient's delay was related to shorter survival; however, Thulesius and others [16][17][18] found no effect of patient's or doctor's delay on long-term survival of ovarian cancer patients. Some authors have claimed that women living in urban areas see their physicians earlier than women living in rural areas, probably because the former have easier access to health services but they may also be more concerned about their symptoms [10].…”

Impact of obesity on diagnosis and treatment of breast cancer

“…Obese women have been shown to be twice as likely to postpone doctor's visit for more than 3 months after occurrence of first symptoms, resulting in advanced stage of disease at presentation [42].…”

Understanding why women delay in seeking help for breast cancer symptoms

“…According to a systematic literature review published in 1999 and subsequent research, there is strong evidence of an association between older age and patient delay [5,6]. The systematic review found less strength of evidence for socioeconomic status and ethnicity and strong evidence that marital status was unrelated to patient delay.…”