Patient's and Doctor's Delay in Primary Breast Cancer: Prognostic implications

Afzelius, Pia; Zedeler, Karin; Sommer, H.; Mouridsen, Henning T.; Blichert-Toft, M

doi:10.3109/02841869409098427

Cited by 105 publications

(104 citation statements)

References 25 publications

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“…This is in agreement with findings from pertinent studies published during the last decade (Coates et al, 1992;Afzelius et al, 1994;Burgess et al, 1998) and is further evidence of a favourable trend towards shorter delay during the last two decades when compared with earlier studies (Cameron and Hinton, 1968;Dennis et al, 1975;Fisher et al, 1977;Elwood and Moorehead, 1980;MacArthur and Smith, 1981;Dohrmann et al, 1982;Vernon et al, 1985;Neale et al, 1986). This trend might be attributable to an increasing health awareness among women due to extensive information campaigns which address breast cancer warning signs in many developed countries.…”

Section: Discussionsupporting

confidence: 90%

“…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%

“…There is quite substantial evidence that among breast cancer cases patient delay of more than 3 months is associated with lower survival whereas no such association has been found for provider delay (Afzelius et al, 1994;Coates, 1999;Richards et al, 1999;Sainsbury et al, 1999).…”

mentioning

confidence: 99%

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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: 90%

Section: Discussionsupporting

confidence: 87%

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

et al. 2002

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“…A study of endometrial cancer in Scotland (Crawford et al, 2002) found that women who experienced the longest delays to surgery were more likely to survive, suggesting that general practitioners were communicating information to consultants, enabling them to respond faster to women at higher risk and decreasing their delay between referral and first hospital visit. A similar interpretation emerged from a study of breast cancer patients in Denmark (Afzelius et al, 1994), where the prognosis was better for patients with a long doctor's delay compared with those with a short delay. The authors concluded that doctors are effective at distinguishing between more and less aggressive tumours.…”

supporting

confidence: 55%

Waiting times for radiotherapy: variation over time and between cancer networks in southeast England

Robinson¹,

Massey²,

Davies³

et al. 2005

Br J Cancer

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The aim of this study was to investigate variations in the length of time that patients with cancer wait from diagnosis to treatment with radiotherapy. A total of 57 426 men and 71 018 women diagnosed with cancer between 1992 and 2001 and receiving radiotherapy within 6 months of diagnosis were identified from the Thames Cancer Registry database. In total, 12 sites were identified for which a substantial number or proportion of patients received radiotherapy: head and neck, oesophagus, colon, rectum, lung, nonmelanoma skin cancer, breast, uterus, prostate, bladder, brain and non-Hodgkin's lymphoma. Median waiting times from diagnosis to radiotherapy were calculated, together with the proportion of patients who received radiotherapy within 60 days of diagnosis, and analysed by year of diagnosis, cancer site, deprivation quintile, age at diagnosis, sex and cancer network of either residence or treatment. Logistic regression was used to adjust the proportion receiving treatment within 60 days for the effects of the other factors. There were significant differences in the proportions receiving radiotherapy within 60 days between different networks and different cancer sites, which remained after adjustment. Median waiting times varied from 42 to 65 days across networks of residence, with the adjusted proportion treated within 60 days ranging from 44 to 71%. There was no difference between male and female patients after adjustment for the other factors, particularly site. There was a highly significant trend over time: the median wait increased from 45 days in 1992 to 76 days in 2001, while the adjusted proportion being treated within 60 days declined by almost a half, from 64 to 35%, over the same period.

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“…Afzelius et al (1994) concluded that physician delay of more than 60 days was not associated with an unfavourable outcome. A systematic review, however, showed that a delay of 3-6 months in symptomatic patients was associated with lower survival (Richards et al, 1999).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2004

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In a prospective study we determined the frequency and causes of delay in the diagnosis of breast cancer after suspicious screening mammography. We included all women aged 50 -75 years who underwent biennial screening mammography in the southern breast cancer screening region of the Netherlands between 1 January 1996 and 1 January 2002. Clinical data, breast imaging reports, biopsy results and breast surgery reports were collected of all women with a positive screening result with a minimum of 2-year follow-up. Of 153 969 mammographic screening examinations, 1615 (1.05%) were positive screens. Breast cancer was diagnosed in 770 (47.9%) of 1607 women for whom follow-up information was available, yielding a cancer detection rate of 5.0 per 1000 women screened. Breast cancer was diagnosed within 3 months following a positive screen in 722 cases (93.8%). The diagnostic delay was 4 -6, 7 -12 and 13 -24 months, respectively, in 11 (1.4%), 24 (3.1%) and nine (1.2%) patients. In four other patients (0.5%), breast cancer was diagnosed after a repeat positive screen, resulting in a diagnostic delay of 25 -27 months. Reasons for a diagnostic delay 43 months were erroneous mammographic interpretation of suspicious lesions as benign or probably benign lesions (33 cases), benign biopsies from a malignant lesion (10), and omission to biopsy or remove a lesion that was suspicious at breast imaging (4) or core biopsy (1). We conclude that there is room for improvement in the workup of patients with a positive screening mammography, as seen from data in this screening region. To improve the workup, we suggest that other breast cancer screening programmes also identify delay in breast cancer diagnosis after a positive screen.

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Patient's and Doctor's Delay in Primary Breast Cancer: Prognostic implications

Cited by 105 publications

References 25 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

Waiting times for radiotherapy: variation over time and between cancer networks in southeast England

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

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