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van der Veer EL, Lameijer J, Coolen AMP, Bluekens AMJ, Nederend J, Gielens M, Voogd A, Duijm L. Causes and consequences of delayed diagnosis in breast cancer screening with a focus on mammographic features and tumour characteristics. Eur J Radiol 2023; 167:111048. [PMID: 37634439 DOI: 10.1016/j.ejrad.2023.111048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/02/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE To study the prevalence, causes and consequences of delayed breast cancer diagnosis in the screening population. METHODS This retrospective study was performed in women who underwent biennial screening mammography between January 1, 2009 and June 30, 2019. Patients were divided into 3 groups; screen-detectedbreast cancer (SDC) without a diagnostic delay, a primary diagnostic delay(i.e. missed cancer at previous screening round)and a delay in diagnostic work-up after recall. Women with a true interval cancer (IC; i.e. not visible on prior examinations) were excluded. Outcome parameters included mammographic and tumour characteristics, lymph node status and surgical treatment. RESULTS In our sample of 4491 women with breast cancer (4292 SDC and 199 'missed' IC), respectively, a total of 1112 women experienced a diagnostic delay of ≥ 4 months. Compared to women without a diagnostic delay (n = 2720), the 176 women with a delay in diagnostic work-up showed overall similar mammographic abnormalities (P = 0.052). These groups show similar distributions in invasive tumours, tumour stage and lymph node status (P = 0.25, P = 0.95 and P = 0.93, respectively). Women with a primary diagnostic delay (n = 936) showed less calcifications (P < 0.001), and more masses with calcifications and architectural distortions on mammography (P = 0.01 and P = 0.04, respectively). Moreover, this group comprised larger tumours (P < 0.001) and lymph node metastases (P < 0.001), and more often underwent mastectomy (P < 0.001). CONCLUSIONS A primary diagnostic delay in breast cancer diagnosis results in less favourable tumour characteristics and relatively more mastectomies compared to no delay in breast cancer diagnosis and a delay in diagnostic work-up after recall.
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Affiliation(s)
- Eline L van der Veer
- Elisabeth TweeSteden Hospital, Hilvarenbeekse Weg 60, 5022 GC, Tilburg, Netherlands.
| | - Joost Lameijer
- Christchurch Hospital, 2 Riccarton Avenue, Christchurch Central City, Christchurch 4710, New-Zealand
| | - Angela M P Coolen
- Elisabeth TweeSteden Hospital, Hilvarenbeekse Weg 60, 5022 GC, Tilburg, Netherlands
| | - Adriana M J Bluekens
- Elisabeth TweeSteden Hospital, Hilvarenbeekse Weg 60, 5022 GC, Tilburg, Netherlands
| | - Joost Nederend
- Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, Netherlands
| | - Maaike Gielens
- Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, Netherlands
| | - Adri Voogd
- Maastricht University, P. Debyelaan 25, 6229 HX, Maastricht, Netherlands
| | - Lucien Duijm
- Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, Netherlands
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Blavin FE, Smith LB, Dubay L, Basurto L. Assessing patterns in cancer screening use by race and ethnicity during the coronavirus pandemic using electronic health record data. Cancer Med 2023; 12:16548-16557. [PMID: 37347148 PMCID: PMC10469733 DOI: 10.1002/cam4.6246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 05/16/2023] [Accepted: 06/02/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Efforts to prevent the spread of the coronavirus led to dramatic reductions in nonemergency medical care services during the first several months of the COVID-19 pandemic. Delayed or missed screenings can lead to more advanced stage cancer diagnoses with potentially worse health outcomes and exacerbate preexisting racial and ethnic disparities. The objective of this analysis was to examine how the pandemic affected rates of breast and colorectal cancer screenings by race and ethnicity. METHODS We analyzed panels of providers that placed orders in 2019-2020 for mammogram and colonoscopy cancer screenings using electronic health record (EHR) data. We used a difference-in-differences design to examine the extent to which changes in provider-level mammogram and colonoscopy orders declined over the first year of the pandemic and whether these changes differed across race and ethnicity groups. RESULTS We found considerable declines in both types of screenings from March through May 2020, relative to the same months in 2019, for all racial and ethnic groups. Some rebound in screenings occurred in June through December 2020, particularly among White and Black patients; however, use among other groups was still lower than expected. CONCLUSIONS This research suggests that many patients experienced missed or delayed screenings during the first few months of the pandemic, which could lead to detrimental health outcomes. Our findings also underscore the importance of having high-quality data on race and ethnicity to document and understand racial and ethnic disparities in access to care.
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Affiliation(s)
- Fredric E. Blavin
- Health Policy CenterUrban InstituteWashingtonDistrict of ColumbiaUSA
| | | | - Lisa Dubay
- Health Policy CenterUrban InstituteWashingtonDistrict of ColumbiaUSA
| | - Luis Basurto
- Duke University, Sanford School of Public PolicyDurhamNorth CarolinaUSA
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3
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Soh JY, Yahya MM, Bachok N, Wan Zain WZ, Wong MPK, Zakaria Z, Hashim Isa Merican SR, Md Hashim MN, Wan Mokhter WM, Ramely R, Zakaria AD, Mohamad IS. Factors associated with delay in seeking care for breast symptoms. BMC Womens Health 2022; 22:316. [PMID: 35897099 PMCID: PMC9331147 DOI: 10.1186/s12905-022-01898-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 07/21/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Breast cancer is the most common cancer in women worldwide. Early detection and intervention are associated with better prognosis and survival. The study aim was to investigate the factors associated with delayed presentation among women with breast symptoms.
Methods
After ethics approval, a cross-sectional study was conducted from January to October 2020 in women with new breast cancer symptoms at their first visit to our clinic. The “Delayed Presentation” questionnaires in the Malay language were used and distributed among the participants. Demographic data and presentation time were recorded. Presentation time was defined as the duration of symptoms prior to visiting any health care facilities. Respondents with presentation times > 90 days comprised the delayed group. The potential factors associated with the delayed presentation were analyzed using cross-tabulation and multiple logistic regression.
Results
There were 106 respondents to the questionnaire, with a mean age of 34.0 (SD: 11.2) years, and 73.6% (n = 78) were < 39 years old. A total of 35.8% (n = 38) visited the local government clinic first and only 28.3% (n = 30) came to the BestARi clinic directly. The reasons for presentation were a palpable breast lump on breast self-examination (75.5%, n = 80), mastalgia (15.1%, n = 16), nipple discharge (5.7%, n = 6), skin changes (0.9%, n = 1), and others (2.8%, n = 3). Among the respondents, 10.4% (n = 11) had alternative treatments prior to presentation to a hospital. The mean presentation time was 98.9 (SD: 323.7) days. Most of the participants (61.3%, n = 65) presented to us within 1 month. The delayed presentation group accounted for 19.8% (n = 21) of the respondents. The factor that was significantly associated with delayed presentation was the participants’ perception of symptoms as not dangerous (adjusted OR 3.05, 95% CI 1.11, 8.38).
Conclusions
The percentage of delayed presentations among our patients was lower than the percentage reported in a previous study. Interpretation of a symptom as harmless by the respondent was the only factor significantly associated with delayed presentation.
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Mahmoud MM, Sanad EF, Elshimy RAA, Hamdy NM. Competitive Endogenous Role of the LINC00511/miR-185-3p Axis and miR-301a-3p From Liquid Biopsy as Molecular Markers for Breast Cancer Diagnosis. Front Oncol 2021; 11:749753. [PMID: 34745973 PMCID: PMC8567754 DOI: 10.3389/fonc.2021.749753] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/15/2021] [Indexed: 12/24/2022] Open
Abstract
Breast cancer (BC) is the leading cause of female cancer-related mortalities. Evidence has illustrated the role of long non-coding RNAs (lncRNA) and microRNAs (miRNA) as promising pool of protein non-coding regulators, for tuning the aggressiveness of several malignancies. This research aims to unravel the expression pattern and the emphases of the diagnostic value of the long intergenic ncRNA00511 (LINC00511) and its downstream microRNA (miR-185-3p) and the pathogenic significance of the onco-miR-301a-3p in naïve BC patients. LINC00511 was chosen and validated, and its molecular binding was confirmed using bioinformatics. LINC00511 was measured in 25 controls and 70 patients using qPCR. The association between the investigated ncRNA’s expression and the BC patients’ clinicopathological features was assessed. Receiver operating characteristic (ROC) curve was blotted to weigh out their diagnostic efficacy over the classical tumor markers (TMs). Bioinformatics and Spearman correlation were used to predict the interaction between LINC00511, miR-185-3p, and miR-301a-3p altogether to patients’ features. LINC00511 and miR-301a-3p, in BC patients’ blood, were overexpressed, and their median levels increased significantly, while miR-185-3p was, in contrast, downregulated, being decreased fourfold. LINC00511 was elevated in BC early stages, when compared to late stages (p < 0.0003). LINC00511, miR-185-3p, and miR-301a-3p showed AUC superior to classical TMs, allowing us to conclude that the investigated ncRNAs, in BC patients’ liquid biopsy, are novel diagnostic molecular biomarker signatures. Lymph node metastasis (LNM) and advanced tumor grade were directly correlated with LINC00511 significantly. Additionally, both LINC00511 and miR-301a-3p were positively correlated with the aggressiveness of BC, as manifested in patients with larger tumors (>2 cm) at (p < 0.001). Therefore, these findings aid our understanding of BC pathogenesis, in the clinical setting, being related in part to the LINC00511/miR axis, which could be a future potential therapeutic target.
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Affiliation(s)
- Marwa M Mahmoud
- Biochemistry Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Eman F Sanad
- Biochemistry Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Reham A A Elshimy
- Clinical and Chemical Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Nadia M Hamdy
- Biochemistry Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
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Miraj S, Saeed H, Jabeen S, Rasool F, Islam M, Zeeshan Danish, Imran I, Hashmi FK, Majeed A, Yasmeen S. Association of breast cancer reporting delays and care intervals with tumor size in patients with advanced disease. Women Health 2021; 61:832-844. [PMID: 34538224 DOI: 10.1080/03630242.2021.1976357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In Pakistan, breast cancer (BC) is frequently diagnosed with advanced disease. We aimed to examine the association of breast tumor size with reasons of reporting delays, care intervals in patients with advanced disease. This cross-sectional study enrolled 392 BC patients from tertiary care hospitals. Data were collected from August 2018-March 2019. Chi-square for significance and logistic regression for association were used. Patients between 31 and 45 years of age (51%), rural residents (39%), lower-class (88.4%), no family history (17.1%), at stage-IV (36%) and patient interval >90 days (70%, p = .034) presented with large tumor size (>5 cm). Tumor size was significantly associated with area of residence (p = .043), social-class (p = .027), family history (p = .004), smoking (p = .021), nipple discharge (p = .004), recurrence (p = .024), and metastasis (p = .007). Patient-interval was associated with poor knowledge (OR;4.3,p = .0001), influence of traditional healers (OR;2.3,p = .05), religion (OR;3.9,p = .0001), finances (OR;2.4,p = .045), and competing life priorities (OR;2.9,p = .026). In-adjusted linear regression model, area of residences, education, social-class, family-history, recurrence, cancer type, and patient interval (β;0.110,p = .030) were found to be independent predictors of tumor size. In conclusion, education, family history, area of residence, social class, recurrence, cancer stage and patient interval, co-influenced by religion, finances, life priorities, traditional healers, and poor knowledge, were independent predictors of tumor size in BC patients.
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Affiliation(s)
- Shumaila Miraj
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Hamid Saeed
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Sumaira Jabeen
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Fawad Rasool
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Muhammad Islam
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Zeeshan Danish
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Imran Imran
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | | | - Abdul Majeed
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Sadia Yasmeen
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
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Chou CP, Lin HS. Delayed Breast Cancer Detection in an Asian Country (Taiwan) with Low COVID-19 Incidence. Cancer Manag Res 2021; 13:5899-5906. [PMID: 34349563 PMCID: PMC8326285 DOI: 10.2147/cmar.s314282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 07/15/2021] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To assess whether the COVID-19 pandemic delayed breast cancer diagnosis in Taiwan, an Asian country with a low COVID-19 incidence. METHODS The monthly volume of breast biopsies and breast cancers during the COVID-19 pandemic (during January 21 and July 31, 2020) was compared to the same period in 2019 (pre-COVID-19). RESULTS Taiwan recorded a lower COVID-19 incidence rate (20.2 cases per million population) than other Asian countries. The screen-detected lesions accounted for 55% and 36% of 2019 and 2020 total biopsied lesions, respectively. Total breast biopsy, mammography-guided, and ultrasound-guided biopsies decreased by 17%, 23%, and 14%, respectively, from pre-COVID-19 to COVID-19. Monthly differences were significant in total biopsy (p=0.03), mammography-guided biopsy (p=0.04), and a benign pathology result after breast biopsy (p<0.01). Nearly 46% decline was noted in the biopsy results of non-invasive breast cancer in 2020. The number of total breast cancers and early breast cancers (stages 0 and 1) decreased by 10% and 38%, respectively, during pandemic. Individuals with early breast cancer accounted for 71% and 49% of the total diagnosed breast cancer in the pre-COVID-19 and COVID-19 periods, respectively (p<0.001). CONCLUSION The pandemic significantly delayed early breast cancer detection in Taiwan despite low COVID-19 incidence. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT04750018.
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Affiliation(s)
- Chen-Pin Chou
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Medical Laboratory Sciences and Biotechnology, Fooling University, Kaohsiung, 807, Taiwan
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Huey-Shyan Lin
- Department of Health-Business Administration, School of Nursing, Fooyin University, Kaohsiung, Taiwan
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7
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Song H, Bergman A, Chen AT, Ellis D, David G, Friedman AB, Bond AM, Bailey JM, Brooks R, Smith‐McLallen A. Disruptions in preventive care: Mammograms during the COVID-19 pandemic. Health Serv Res 2021; 56:95-101. [PMID: 33146429 PMCID: PMC7839639 DOI: 10.1111/1475-6773.13596] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To measure the extent to which the provision of mammograms was impacted by the COVID-19 pandemic and surrounding guidelines. DATA SOURCES De-identified summary data derived from medical claims and eligibility files were provided by Independence Blue Cross for women receiving mammograms. STUDY DESIGN We used a difference-in-differences approach to characterize the change in mammograms performed over time and a queueing formula to estimate the time to clear the queue of missed mammograms. DATA COLLECTION We used data from the first 30 weeks of each year from 2018 to 2020. PRINCIPAL FINDINGS Over the 20 weeks following March 11, 2020, the volume of screening mammograms and diagnostic mammograms fell by 58% and 38% of expected levels, on average. Lowest volumes were observed in week 15 (April 8 to 14), when screening and diagnostic mammograms fell by 99% and 74%, respectively. Volumes began to rebound in week 19 (May), with diagnostic mammograms reaching levels to similar to previous years' and screening mammograms remaining 14% below expectations. We estimate it will take a minimum of 22 weeks to clear the queue of missed mammograms in our study sample. CONCLUSIONS The provision of mammograms has been significantly disrupted due to the COVID-19 pandemic.
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Affiliation(s)
- Hummy Song
- Operations, Information and Decisions DepartmentThe Wharton SchoolUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Alon Bergman
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Health Care Management DepartmentThe Wharton SchoolUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Angela T. Chen
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Dan Ellis
- Independence Blue CrossPhiladelphiaPennsylvaniaUSA
| | - Guy David
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Health Care Management DepartmentThe Wharton SchoolUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Ari B. Friedman
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Emergency MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Medical Ethics and Health PolicyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Amelia M. Bond
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Population Health SciencesWeill Cornell Medical CollegeNew YorkNew YorkUSA
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8
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Groome PA, Webber C, Whitehead M, Moineddin R, Grunfeld E, Eisen A, Gilbert J, Holloway C, Irish JC, Langley H. Determining the Cancer Diagnostic Interval Using Administrative Health Care Data in a Breast Cancer Cohort. JCO Clin Cancer Inform 2020; 3:1-10. [PMID: 31112418 PMCID: PMC6874005 DOI: 10.1200/cci.18.00131] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Population-based administrative health care data could be a valuable resource with which to study the cancer diagnostic interval. The objective of the current study was to determine the first encounter in the diagnostic interval and compute that interval in a cohort of patients with breast cancer using an empirical approach. METHODS This is a retrospective cohort study of patients with breast cancer diagnosed in Ontario, Canada, between 2007 and 2015. We used cancer registry, physician claims, hospital discharge, and emergency department visit data to identify and categorize cancer-related encounters that were more common in the three months before diagnosis. We used statistical control charts to define lookback periods for each encounter category. We identified the earliest cancer-related encounter that marked the start of the diagnostic interval. The end of the interval was the cancer diagnosis date. RESULTS The final cohort included 69,717 patients with breast cancer. We identified an initial encounter in 97.8% of patients. Median diagnostic interval was 36 days (interquartile range [IQR], 19 to 71 days). Median interval decreased with increasing stage at diagnosis and varied across initial encounter categories, from 9 days (IQR, 1 to 35 days) for encounters with other cancer as the diagnosis to 231 days (IQR 77 to 311 days) for encounters with cyst aspiration or drainage as the procedure. CONCLUSION Diagnostic interval research can inform early detection guidelines and assess the success of diagnostic assessment programs. Use of administrative data for this purpose is a powerful tool for improving diagnostic processes at the population level.
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Affiliation(s)
- Patti A Groome
- Queen's University, Kingston, Ontario, Canada.,ICES Queen's, Kingston, Ontario, Canada
| | - Colleen Webber
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | | | - Eva Grunfeld
- University of Toronto, Toronto, Ontario, Canada.,Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Andrea Eisen
- University of Toronto, Toronto, Ontario, Canada.,Cancer Care Ontario, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Julie Gilbert
- University of Toronto, Toronto, Ontario, Canada.,Cancer Care Ontario, Toronto, Ontario, Canada
| | | | | | - Hugh Langley
- Queen's University, Kingston, Ontario, Canada.,South East Regional Cancer Program, Kingston, Ontario, Canada
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9
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Rangel-Méndez JA, Novelo-Tec JF, Sánchez-Cruz JF, Cedillo-Rivera R, Moo-Puc RE. Healthcare delay in breast cancer patients: a case study in a low-density population region from Mexico. Future Oncol 2018; 14:2067-2082. [DOI: 10.2217/fon-2017-0713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To describe delay intervals, their impact on clinical stage and initiation of first oncologic treatment, and evaluate associated factors in breast cancer patients in Yucatan, Mexico, a low-density population region. Patients & methods: A retrospective analysis was done of 92 medical records, and bivariate and multivariate models applied to identify associations between healthcare delay and several factors. Results: System delay accounted for most of the delay (median: 86 days; 61% of delay). Socioeconomic status and delivery to tertiary-care hospital predicted delay. Clinical stage determined initiation of first oncologic treatment. Conclusion: Delay in treatment was largely due to system delay. Only a few variables explained this delay. Clinical stage had the strongest effect on initiation of first oncologic treatment.
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Affiliation(s)
- Jorge Aarón Rangel-Méndez
- Unidad de Investigación Médica Yucatán, Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional “Ignacio García Téllez”, Instituto Mexicano del Seguro Social, Calle 41 No. 439, Col. Industrial, Mérida, Yucatán 97150, México
| | - José Feliciano Novelo-Tec
- Unidad de Medicina Familiar número 58, Delegación Estatal Yucatán, Instituto Mexicano del Seguro Social, Calle 42 999 X 127 A Y 131, Serapio Rendón II, Mérida, Yucatán 97285, México
| | - Juan Francisco Sánchez-Cruz
- Coordinación de Investigación, Delegación Estatal Yucatán, Instituto Mexicano del Seguro Social, Calle 41 No. 439, Col. Industrial, Mérida, Yucatán 97150, México
| | - Roberto Cedillo-Rivera
- Unidad Interinstitucional de Investigación Clínica y Epidemiológica, Facultad de Medicina, Universidad Autónoma de Yucatán, Avenida Itzáes No. 498 x 86 Y 59A, Centro, Mérida, Yucatán 97000, México
| | - Rosa Esther Moo-Puc
- Unidad de Investigación Médica Yucatán, Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional “Ignacio García Téllez”, Instituto Mexicano del Seguro Social, Calle 41 No. 439, Col. Industrial, Mérida, Yucatán 97150, México
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Abstract
OBJECTIVE The objective was to assess the clinical presentation, delay of diagnosis, and the causes of delay in the diagnosis of patients with pregnancy-associated breast cancer (PABC) and patients with non-PABC. PATIENTS AND METHODS This was a face-to-face interview with women who had histologically confirmed BC. All respondents were interviewed at our hospital. RESULTS We interviewed 56 patients, 36 with non-PABC and 20 with PABC. Of the 20 patients with PABC, BC was diagnosed in 12 (60%) during pregnancy and 8 (40%) during postpartum. 18 of the patients (90%) with PABC presented mainly with a mass 3 (15%) with pain and ulcer, 5 (25%) with skin redness and thickening, 6 (30%) with nipple retraction and 4 (20%) with discharge 12 (60%) patients with PABC had delayed diagnosis and 8 (40%) of this delay was due to physicians' reassurance, and 2 (10%) because of fear of cancer. Similarly, 35 (97%) patients with non-PABC presented with breast mass, 3 (8.3%) with infrequent pain 4 (11.11%) with inflammation 2 (5.55%) with ulcer 2 (5.55%) with nipple discharge and4 (11.11%) with thickening of the skin compared with PABC patients. Only 4 (11.11%) in non-PABC had delayed diagnosis, and for half of them the delay was due to the fear of cancer. Two patients with PABC and non-PABC were afraid of cancer 16.66% and 5.55%, respectively. However, 8 (60%) of patients with PABC had delayed diagnosis compared to 0% of patients with non-PABC. CONCLUSION In this study, the majority of patients with PABC or non-PABC presented with a breast lump. Other symptoms were more common in patients with PABC than in patients with non-PABC. An increased awareness of clinicians may help reduce delay in the diagnosis of patients with PABC.
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Affiliation(s)
- Ali M Al-Amri
- Department of Internal Medicine and Oncology, College of Medicine, University of Dammam, King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia
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11
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Shieh SH, Hsieh VCR, Liu SH, Chien CR, Lin CC, Wu TN. Delayed time from first medical visit to diagnosis for breast cancer patients in Taiwan. J Formos Med Assoc 2014; 113:696-703. [DOI: 10.1016/j.jfma.2012.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 11/29/2012] [Accepted: 12/11/2012] [Indexed: 10/27/2022] Open
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12
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Müller CSL, Pföhler C, Kohn D, Vogt T. Huge undifferentiated fibroblastic sarcoma of the foot and lower leg: impact of diagnostic delay and discussion of an entity. BMJ Case Rep 2013; 2013:bcr-2013-200192. [PMID: 24121812 DOI: 10.1136/bcr-2013-200192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report a case of a 40-year-old female patient with a huge fibroblastic differentiated sarcoma of the left foot. After sampling all clinical, pathological and imaging information, the case was presented to the interdisciplinary tumour conference. Further treatment and medical care took place in the department of orthopaedics and orthopaedic surgery of our university hospital. Treatment consisted of amputation of the left foot and lower leg as an extremity-preserving surgical procedure was not possible because clear surgical margins could not be achieved with preservation of a functional rest of ankle and foot. Till date, no metastases have occurred.
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Jassem J, Ozmen V, Bacanu F, Drobniene M, Eglitis J, Lakshmaiah KC, Kahan Z, Mardiak J, Pieńkowski T, Semiglazova T, Stamatovic L, Timcheva C, Vasovic S, Vrbanec D, Zaborek P. Delays in diagnosis and treatment of breast cancer: a multinational analysis. Eur J Public Health 2013; 24:761-7. [PMID: 24029456 DOI: 10.1093/eurpub/ckt131] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Reducing treatment delay improves outcomes in breast cancer. The aim of this study was to determine factors influencing patient- and system-related delays in commencing breast cancer treatment in different countries. METHODS A total of 6588 female breast cancer patients from 12 countries were surveyed. Total delay time was determined as the sum of the patient-related delay time (time between onset of the first symptoms and the first medical visit) and system-related delay time (time between the first medical visit and the start of therapy). RESULTS The average patient-related delay time and total delay time were 4.7 (range: 3.4-6.2) weeks and 14.4 (range: 11.5-29.4) weeks, respectively. Longer patient-related delay times were associated with distrust and disregard, and shorter patient-related delay times were associated with fear of breast cancer, practicing self-examination, higher education level, being employed, having support from friends and family and living in big cities. The average system-related delay time was 11.1 (range: 8.3-24.7) weeks. Cancer diagnosis made by an oncologist versus another physician, higher education level, older age, family history of female cancers and having a breast lump as the first cancer sign were associated with shorter system-related delay times. Longer patient-related delay times and higher levels of distrust and disregard were predictors of longer system-related delay times. CONCLUSIONS The delay in diagnosis and treatment of breast cancer remains a serious problem. Several psychological and behavioural patient attributes strongly determine both patient-related delay time and system-related delay time, but their strength is different in particular countries.
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Affiliation(s)
- Jacek Jassem
- 1 Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Vahit Ozmen
- 2 Department of Surgery, Istanbul University, Istanbul, Turkey
| | - Florin Bacanu
- 3 Departament of Clinical Oncology, Sf Maria Hospital, Bucharest, Romania
| | - Monika Drobniene
- 4 Radiotherapy and Drug Therapy Center, Institute of Oncology, Vilnius University, Vilnius, Lithuania
| | - Janis Eglitis
- 5 Department of Breast Surgery, Oncology Centre of Latvia, Riga East University Hospital, Riga, Latvia
| | | | - Zsuzsanna Kahan
- 7 Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Jozef Mardiak
- 8 2nd Department of Oncology, National Cancer Institute and Medical School of Comenius University, Bratislava, Slovak Republic
| | - Tadeusz Pieńkowski
- 9 Department of Oncology and Surgery, Medical Centre of Postgraduate Education, Otwock, Poland
| | - Tatiana Semiglazova
- 10 Department of Medical Oncology, Petrov Research Institute of Oncology, St. Petersburg, Russia
| | - Ljiljana Stamatovic
- 11 Department of Medical Oncology, Institute of Oncology and Radiology, Belgrade, Serbia
| | - Constanta Timcheva
- 12 Department of Chemotherapy, Specialized Hospital for Active Treatment in Oncology, Sofia, Bulgaria
| | - Suzana Vasovic
- 11 Department of Medical Oncology, Institute of Oncology and Radiology, Belgrade, Serbia
| | - Damir Vrbanec
- 13 Department of Medical Oncology, Clinic of Oncology, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Piotr Zaborek
- 14 Collegium of World Economy, Warsaw School of Economics, Warsaw, Poland
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McLaughlin JM, Anderson RT, Ferketich AK, Seiber EE, Balkrishnan R, Paskett ED. Effect on survival of longer intervals between confirmed diagnosis and treatment initiation among low-income women with breast cancer. J Clin Oncol 2012; 30:4493-500. [PMID: 23169521 DOI: 10.1200/jco.2012.39.7695] [Citation(s) in RCA: 139] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To determine the impact of longer periods between biopsy-confirmed breast cancer diagnosis and the initiation of treatment (Dx2Tx) on survival. PATIENTS AND METHODS This study was a noninterventional, retrospective analysis of adult female North Carolina Medicaid enrollees diagnosed with breast cancer from January 1, 2000, through December, 31, 2002, in the linked North Carolina Central Cancer Registry-Medicaid Claims database. Follow-up data were available through July 31, 2006. Cox proportional hazards regression models were constructed to evaluate the impact on survival of delaying treatment ≥ 60 days after a confirmed diagnosis of breast cancer. RESULTS The study cohort consisted of 1,786 low-income, adult women with a mean age of 61.6 years. A large proportion of the patients (44.3%) were racial minorities. Median time from biopsy-confirmed diagnosis to treatment initiation was 22 days. Adjusted Cox proportional hazards regression showed that although Dx2Tx length did not affect survival among those diagnosed at early stage, among late-stage patients, intervals between diagnosis and first treatment ≥ 60 days were associated with significantly worse overall survival (hazard ratio [HR], 1.66; 95% CI, 1.00 to 2.77; P = .05) and breast cancer-specific survival (HR, 1.85; 95% CI, 1.04 to 3.27; P = .04). CONCLUSION One in 10 women waited ≥ 60 days to initiate treatment after a diagnosis of breast cancer. Waiting ≥ 60 days to initiate treatment was associated with a significant 66% and 85% increased risk of overall and breast cancer-related death, respectively, among late-stage patients. Interventions designed to increase the timeliness of receiving breast cancer treatments should target late-stage patients, and clinicians should strive to promptly triage and initiate treatment for patients diagnosed at late stage.
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Warner ET, Tamimi RM, Hughes ME, Ottesen RA, Wong YN, Edge SB, Theriault RL, Blayney DW, Niland JC, Winer EP, Weeks JC, Partridge AH. Time to diagnosis and breast cancer stage by race/ethnicity. Breast Cancer Res Treat 2012; 136:813-21. [PMID: 23099438 DOI: 10.1007/s10549-012-2304-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 10/13/2012] [Indexed: 01/07/2023]
Abstract
We examined differences in time to diagnosis by race/ethnicity, the relationship between time to diagnosis and stage, and the extent to which it explains differences in stage at diagnosis across racial/ethnic groups. Our analytic sample includes 21,427 non-Hispanic White (White), Hispanic, non-Hispanic Black (Black) and non-Hispanic Asian/Pacific Islander (Asian) women diagnosed with stage I to IV breast cancer between January 1, 2000 and December 31, 2007 at one of eight National Comprehensive Cancer Network centers. We measured time from initial abnormal mammogram or symptom to breast cancer diagnosis. Stage was classified using AJCC criteria. Initial sign of breast cancer modified the association between race/ethnicity and time to diagnosis. Among symptomatic women, median time to diagnosis ranged from 36 days among Whites to 53.6 for Blacks. Among women with abnormal mammograms, median time to diagnosis ranged from 21 days among Whites to 29 for Blacks. Blacks had the highest proportion (26 %) of Stage III or IV tumors. After accounting for time to diagnosis, the observed increased risk of stage III/IV breast cancer was reduced from 40 to 28 % among Hispanics and from 113 to 100 % among Blacks, but estimates remained statistically significant. We were unable to fully account for the higher proportion of late-stage tumors among Blacks. Blacks and Hispanics experienced longer time to diagnosis than Whites, and Blacks were more likely to be diagnosed with late-stage tumors. Longer time to diagnosis did not fully explain differences in stage between racial/ethnicity groups.
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Affiliation(s)
- Erica T Warner
- Department of Epidemiology, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA.
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Fayanju OM, Jeffe DB, Elmore L, Ksiazek DN, Margenthaler JA. Patient and process factors associated with late-stage breast cancer diagnosis in Safety-Net patients: a pilot prospective study. Ann Surg Oncol 2012; 20:723-32. [PMID: 23070783 DOI: 10.1245/s10434-012-2558-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Indexed: 01/07/2023]
Abstract
BACKGROUND Following reforms to our city's Safety-Net (SN) breast cancer referral process, we investigated whether factors often associated with late-stage diagnosis would differ by referral source--SN versus non-Safety-Net (NSN)--or, among SN patients, by stage at diagnosis. METHODS From September 2008 to June 2010, SN patients with any-stage (0-IV) and NSN patients with late-stage (IIB-IV) breast cancer were identified prospectively during initial cancer-center consultations. Data were analyzed using logistic regression, chi-square, and t tests; two-tailed P < 0.05 was considered significant. RESULTS Fifty-seven women completed interviews (33 SN, 24 NSN); 52% of SN-referred patients were diagnosed with late-stage disease. Compared with NSN late-stage patients, SN late-stage patients were more likely to be African-American (83% vs. 21%, P < 0.001), to have an annual household income <$25,000 (89% vs. 38%, P < 0.001), and to report having a health problem in the preceding year but not being able to see a doctor because of cost (67% vs. 25%, P = 0.012); they were less likely to be married/partnered (22% vs. 79%, P < 0.001) and to have post-college education (0% vs. 25%, P < 0.03), any insurance (61% vs. 96%, P < 0.005), and to have sought medical attention within 1 week of realizing they had concerning breast findings (50% vs. 79%, P = 0.047). Married/partnered patients were more likely to delay medical care by >1 week (odds ratio = 9.9, P = 0.038). CONCLUSIONS SN patients presented with higher-than-expected rates of late-stage disease despite improvements in mammography rates and the referral process. Efforts to further facilitate access to care for this vulnerable SN patient population are needed.
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Purushothaman H, Wilson R, Michell M. Medico-legal issues in breast imaging. Clin Radiol 2012; 67:638-42. [DOI: 10.1016/j.crad.2011.08.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 07/17/2011] [Accepted: 08/01/2011] [Indexed: 10/14/2022]
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Price AJ, Ndom P, Atenguena E, Mambou Nouemssi JP, Ryder RW. Cancer care challenges in developing countries. Cancer 2011; 118:3627-35. [PMID: 22223050 DOI: 10.1002/cncr.26681] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 10/10/2011] [Accepted: 10/11/2011] [Indexed: 01/27/2023]
Abstract
BACKGROUND Health systems in Sub-Saharan Africa are not prepared for the rapid rise in cancer rates projected in the region over the next decades. More must be understood about the current state of cancer care in this region to target improvement efforts. Yaounde General Hospital (YGH) currently is the only site in Cameroon (population: 18.8 million) where adults can receive chemotherapy from trained medical oncologists. The experiences of patients at this facility represent a useful paradigm for describing cancer care in this region. METHODS In July and August 2010, our multidisciplinary team conducted closed-end interviews with 79 consecutive patients who had confirmed breast cancer, Kaposi sarcoma, or lymphoma. RESULTS Thirty-five percent of patients waited >6 months to speak to a health care provider after the first sign of their cancer. The delay between first consultation with a health care provider and receipt of a cancer diagnosis was >3 months for 47% of patients. The total delay from the first sign of cancer to receipt of the correct diagnosis was >6 months for 63% of patients. Twenty-three percent of patients traveled for >7 hours to reach YGH, and 40% of patients interviewed spent >$200 on a single round of chemotherapy. CONCLUSIONS Cancer patients experienced numerous geographic and health care system challenges, resulting in significant delays in receiving diagnosis and treatment, even for cancers highly amenable to early intervention. This unacceptable and unethical situation is likely explained by limited knowledge about cancer among patients and health care professionals, government neglect, poverty, and reliance on traditional healers.
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Affiliation(s)
- Adi J Price
- School of Medicine, University of California-San Diego, San Diego, CA 92093, USA.
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Stuver SO, Zhu J, Simchowitz B, Hassett MJ, Shulman LN, Weingart SN. Identifying Women at Risk of Delayed Breast Cancer Diagnosis. Jt Comm J Qual Patient Saf 2011; 37:568-AP2. [DOI: 10.1016/s1553-7250(11)37073-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Chintamani, Tuteja A, Khandelwal R, Tandon M, Bamal R, Jain S, Narayan N, Srinivas S, Kumar Y. Patient and provider delays in breast cancer patients attending a tertiary care centre: a prospective study. JRSM Short Rep 2011; 2:76. [PMID: 22046495 PMCID: PMC3205556 DOI: 10.1258/shorts.2011.011006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To find out factors that are responsible for the patient or provider delays in the diagnosis of breast cancer in India. DESIGN This prospective study was designed to be conducted over a period of two years including a cohort of 100 patients with locally advanced breast cancer. The delays were assessed using questionnaires prepared according to the Indian scenario. SETTING A prospective study in an Indian setting. PARTICIPANTS One hundred patients with locally advanced breast cancer receiving neoadjuvant chemotherapy were included after providing informed consent and receiving ethical committee clearance. MAIN OUTCOME MEASURES The most common factor responsible for delays in diagnosis was observed to be the health providers, although illiteracy and lack of adequate healthcare services also contributed significantly. Unregistered medical practitioners or quacks contributed significantly to the delays in reporting and diagnosis of the disease. RESULTS One hundred patients of locally advanced breast cancer were evaluated using standardized questionnaires to assess the delays in diagnosis. Provider delays were found to be significant (the unregistered doctors or quacks being a significant cause of delays).The average time lapse before diagnosis for rural patients was higher (67.5 days) compared to urban patients (53.7 days). The literacy levels of the patients also had a significant impact on the delays at diagnosis. The delay in illiterates was 60.6 days compared to 49.5 days for literates. CONCLUSIONS The most common factor responsible for delays in reporting and diagnosis was observed to be at the end of the health providers, although illiteracy and lack of adequate healthcare services also contributed significantly. Unregistered medical practitioners or quacks contributed significantly to the delays in reporting and diagnosis of the disease.
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Affiliation(s)
- Chintamani
- Department of Surgery and Vardhman Mahavir Medical College, Safdarjang Hospital , New Delhi , India
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Ceballos-García GJ, Giraldo-Mora CV. Women's Self-imposed Barriers to Timely Diagnosis and Treatment of Breast Cancer. Aquichan 2011. [DOI: 10.5294/aqui.2011.11.2.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objetivo: describir las barreras que impiden a las mujeres con cáncer de mama (CaMa) acceder a los servicios de salud y adoptar hábitos favorables para la detección precoz y el tratamiento oportuno. Materiales y métodos: estudio cualitativo basado en la teoría fundamentada; la recolección de los datos se hizo a través de entrevistas semiestructuradas a 13 mujeres entre los 24 y 77 años de edad, con diagnóstico de CaMa, realizado entre el 2006 y 2008 en Medellín, Colombia. Resultados: se describen “autobarreras” como: el temor a los ámbitos y tratamientos médicos, el retraso para consultar por considerar prioritarios los compromisos laborales y familiares, y las experiencias terapéuticas negativas. Conclusiones: el estudio muestra que las “autobarreras” impiden el diagnóstico y tratamiento oportuno de CaMa, estas no pueden ser explicadas desde una visión simplista y aislada; el ser humano es el resultado de su contexto, sus vivencias personales y su relación con los otros. Uno de los principales hallazgos fue la descripción de un proceso en el que las mujeres finalmente desarrollan una nueva lógica frente al riesgo del CaMa que les permite pensar en el autocuidado y el cuidado de los otros como sujetos de riesgo.
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Norsa'adah B, Rampal KG, Rahmah MA, Naing NN, Biswal BM. Diagnosis delay of breast cancer and its associated factors in Malaysian women. BMC Cancer 2011; 11:141. [PMID: 21496310 PMCID: PMC3101177 DOI: 10.1186/1471-2407-11-141] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Accepted: 04/17/2011] [Indexed: 02/07/2023] Open
Abstract
Background Breast cancer is the leading cause of cancer mortality among women in Malaysia. Delayed diagnosis is preventable and has major effects on patients' prognosis and survival. The objectives of our study were to identify the magnitude of delayed diagnosis and its associated factors in women with breast cancer in Malaysia. Methods This study had a cross-sectional design. Respondents had histologically confirmed breast cancer and were registered at five medical centres between 2005 and 2007. All breast cancer patients who attended hospital clinics at the East Coast were included. Patients at Kuala Lumpur hospitals were selected by systematic sampling. A standardised questionnaire was developed to interview respondents. We measured the time from the first recognition of symptoms to the first general practitioners' consultation and to the histological diagnosis of breast cancer. Diagnosis delay was defined when there was more than 6 months from the recognition of symptoms to the histological diagnosis. Multiple logistic regression was used for analysis. Results In total, 328 respondents were included. The mean (standard deviation) age was 47.9 (9.4) years. Most respondents were of Malay ethnicity, were married housewives with a median family income of RM1500 a month. Most respondents had ductal carcinoma (89.3%) and the stage distribution was as follows: 5.2% stage I, 38.7% stage II, 44.8% stage III and 11.3% stage IV. The median time to consultation was 2 months and the median time to diagnosis was 5.5 months. The frequency of diagnosis delay of more than 3 months was 72.6% and delay of more than 6 months occurred in 45.5% of the cases. The factors associated with diagnosis delay included the use of alternative therapy (odds ratio (OR) 1.77; 95% confidence interval (CI): 1.06, 2.94), breast ulcer (OR 5.71; 95% CI: 1.59, 20.47), palpable axillary lymph nodes (OR 2.19; 95% CI: 1.23, 3.90), false-negative diagnostic test (OR 5.32; 95% CI: 2.32, 12.21), non-cancer interpretation (OR 1.68; 95% CI: 1.01, 2.78) and negative attitude toward treatment (OR 2.09; 95% CI: 1.15, 3.82). Conclusions Delays in consultation and diagnosis are serious problems in Malaysia. Diagnosis delay was influenced by complex interactions between many factors. Breast awareness and education are required to promote early detection, diagnosis and treatment before the tumours enlarge and metastasis.
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Affiliation(s)
- Bachok Norsa'adah
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
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Sharpe D, Williams RN, Ubhi SS, Sutton CD, Bowrey DJ. The "two-week wait" referral pathway allows prompt treatment but does not improve outcome for patients with oesophago-gastric cancer. Eur J Surg Oncol 2010; 36:977-81. [PMID: 20702059 DOI: 10.1016/j.ejso.2010.07.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 06/22/2010] [Accepted: 07/15/2010] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION The Two Week Wait Referral Service (2WW) has been implemented as a means of fast-tracking patients with suspected upper gastrointestinal cancers for endoscopy. Whether or not it impacts on the outcome of these patients is unclear. The aim of this study was to compare the outcome of patients referred through 2WW with that of patients with oesophago-gastric cancer identified through alternate referral pathways (routine, emergency). METHODS The study population was 340 patients with oesophago-gastric carcinoma (gastric 154) diagnosed during the time period 01/2006-12/2007 at University Hospitals of Leicester NHS Trust. Data were collected prospectively by the MDT co-ordinator and analysed retrospectively. RESULTS 135 of the 340 patients with oesophago-gastric cancer were diagnosed through the 2WW, 115 patients through routine referral pathways, and 90 patients were admitted on an emergency basis. Patients referred through 2WW had a median referral to 1st treatment time of 47 days (routine 79, emergency 28, p < 0.001 all group comparisons). The number of patients treated with potentially curative intent was 37 of 135 for the 2WW, 42 of 115 for the routine referrals and 10 of 90 for patients admitted as emergencies. The corresponding median survivals for the groups were 239 days (2WW), 405 days (routine) and 121 days (emergency), p < 0.001 (log rank). CONCLUSIONS Referral by 2WW resulted in more rapid treatment than routine referral but this did not translate into an improvement in survival. This suggests that the targeting of endoscopy to patients with alarm symptoms is flawed and a less selective approach should be promoted if curable cancers are to be detected.
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Affiliation(s)
- D Sharpe
- University Hospitals of Leicester NHS Trust, Department of Surgery, Leicester Royal Infirmary, UK
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van den Biggelaar FJHM, Kessels AGH, van Engelshoven JMA, Flobbe K. Costs and effects of using specialized breast technologists in prereading mammograms in a clinical patient population. Int J Technol Assess Health Care 2009; 25:505-13. [DOI: 10.1017/s0266462309990377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objectives: The aim of this study was to assess the costs and effects of using specialized breast technologists in prereading mammograms to reduce the increasing workload of radiologists in daily clinical practice. Mammography is the most widely used imaging modality for early detection and diagnosis of breast cancer.Methods: A total of 1389 mammograms of consecutive patients were evaluated by two technologists trained in mammogram interpretation. The costs and effects of four different experimental strategies of prereading mammograms by technologists were analyzed by decision analytic modeling and compared with the conventional strategy of standard evaluation by the radiologist on duty.Results: Overall, the employment of technologists in this patient population resulted in a potential time saving up to 73 percent (1019/1389) for the radiologist. No additional false-negative imaging results were found as compared to the conventional strategy. The total diagnostic costs in the conventional strategy were determined at €150,602. The experimental strategies resulted in cost savings up to 17.2 percent (range, €122,494–€139,781).Conclusions: The employment of technologists in prereading mammograms in a clinical patient population could be effective to reduce the workload of radiologists without jeopardizing the detection of malignancies. Furthermore, diagnostic costs can be reduced considerably.
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Abel GA, Friese CR, Magazu LS, Richardson LC, Fernandez ME, De Zengotita JJ, Earle CC. Delays in referral and diagnosis for chronic hematologic malignancies: A literature review. Leuk Lymphoma 2009; 49:1352-9. [PMID: 18604724 DOI: 10.1080/10428190802124281] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Weingart SN, Saadeh MG, Simchowitz B, Gandhi TK, Nekhlyudov L, Studdert DM, Puopolo AL, Shulman LN. Process of care failures in breast cancer diagnosis. J Gen Intern Med 2009; 24:702-9. [PMID: 19387748 PMCID: PMC2686776 DOI: 10.1007/s11606-009-0982-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Revised: 02/12/2009] [Accepted: 03/30/2009] [Indexed: 12/28/2022]
Abstract
BACKGROUND Process of care failures may contribute to diagnostic errors in breast cancer care. OBJECTIVE To identify patient- and provider-related process of care failures in breast cancer screening and follow-up in a non-claims-based cohort. DESIGN Retrospective chart review of a cohort of patients referred to two Boston cancer centers with new breast cancer diagnoses between January 1, 1999 and December 31, 2004. PARTICIPANTS We identified 2,275 women who reported > or =90 days between symptom onset and breast cancer diagnosis or presentation with at least stage II disease. We then selected the 340 (14.9%) whose physicians shared an electronic medical record. We excluded 238 subjects whose records were insufficient for review, yielding a final cohort of 102 patients. INTERVENTIONS None MEASUREMENTS We tabulated the number and types of process of care failures and examined risk factors using bivariate analyses and multivariable Poisson regression. MAIN RESULTS Twenty-six of 102 patients experienced > or =1 process of care failure. The most common failures occurred when physicians failed to perform an adequate physical examination, when patients failed to seek care, and when diagnostic or laboratory tests were ordered but patients failed to complete them. Failures were attributed in similar numbers to provider- and patient-related factors (n = 30 vs. n = 25, respectively). Process of care failures were more likely when the patient's primary care physician was male (IRR 2.8, 95% CI 1.2 to 6.5) and when the patient was non-white (IRR 2.8, 95% CI 1.4 to 5.7). CONCLUSIONS Process failures were common in this patient cohort, with both clinicians and patients contributing to breakdowns in the diagnostic process.
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Affiliation(s)
- Saul N Weingart
- Center for Patient Safety, Dana-Farber Cancer Institute, 44 Binney St., Boston, MA, 02115, USA.
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Duijm LEM, Groenewoud JH, de Koning HJ, Coebergh JW, van Beek M, Hooijen MJHH, van de Poll-Franse LV. Delayed diagnosis of breast cancer in women recalled for suspicious screening mammography. Eur J Cancer 2008; 45:774-81. [PMID: 19046632 DOI: 10.1016/j.ejca.2008.10.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2008] [Revised: 10/19/2008] [Accepted: 10/24/2008] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine the frequency, pathology and causes of a delay in cancer diagnosis in women recalled for suspicious screening mammography. METHODS We included all 290,943 screening mammograms of women aged 50-75 years, who underwent biennial screening mammography between 1st January 1995 and 1st January 2006. During a follow-up period of at least 2 years, clinical data, breast imaging reports, biopsy results and breast surgery reports were collected of all 3513 women with a positive screening result. Tumour stages of breast cancers with a diagnostic delay (defined as breast cancer confirmation more than 3 months following a positive mammography screen) were compared with those of cancers diagnosed within 3 months following referral and with interval cancers. RESULTS A diagnostic delay occurred in 97 (6.5%) of 1503 screen-detected cancers. These 97 false-negative assessments comprised significantly more ductal cancers in situ (26.8%) than did cancers with an adequate assessment after recall (15.5%, p=0.004) or interval cancers (3.7%, p<0.001). Compared with interval cancers, cancers with a false-negative assessment had a more favourable tumour size (T1a-c, 87.3% versus T1a-c, 46.4%; p<0.001) and showed significantly fewer cases with axillary lymph node metastases (22.5% versus 48.2%; p<0.001). Between hospitals having performed the workup of at least 500 referred women each, the percentage of women with a false-negative assessment varied from 5.0% to 9.1% (p=0.03). In these hospitals, improper classification of lesions at diagnostic mammography comprised 64.4% of false-negative assessments. CONCLUSION We found that 6.5% of recalled women experienced a delay in breast cancer diagnosis, with significant performance variations between hospitals.
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Affiliation(s)
- Lucien E M Duijm
- Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands.
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Pinkney TD, Raman S, Piramanayagam B, Corder AP. The results of a structured diagnostic pathway designed to minimise the chance of breast cancer misdiagnosis. Eur J Surg Oncol 2007; 33:551-5. [PMID: 17336481 DOI: 10.1016/j.ejso.2007.01.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Accepted: 01/17/2007] [Indexed: 11/15/2022] Open
Abstract
AIM To describe results from a structured clinic pathway designed to minimise inaccuracies and diagnostic delays in the diagnosis of breast cancer. METHODS Patients referred to our breast clinic undergo clinical, imaging and biopsy assessment according to a standard protocol. Over 4 years, patients who were discharged with a benign diagnosis and later found to have breast cancer were reviewed. RESULTS A total of 4366 new referrals were seen in the symptomatic breast clinic and 571 (13%) new cancers were diagnosed. Fourteen of the new cancer patients had been seen in the clinic previously (range 7-48 months) and discharged with a benign diagnosis. None of these tumours appeared to result from misdiagnosis of a lesion previously assessed to be benign. The rate of development of cancer in the cohort discharged with a benign diagnosis was closely similar to that in the normal United Kingdom population. CONCLUSIONS A structured breast clinic pathway can produce a rate of diagnostic accuracy closely approaching 100%.
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Affiliation(s)
- T D Pinkney
- Department of Surgery, The County Hospital, Union Walk, Hereford, HR1 2ER, UK
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Miedema BB, Easley J, Hamilton R. Young adults' experiences with cancer: comments from patients and survivors. Can Fam Physician 2006; 52:1446-7. [PMID: 17279205 PMCID: PMC1783700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To examine the experiences with cancer of adults diagnosed when between 20 and 35 years old. DESIGN Qualitative study using semistructured interviews. SETTING Largest health care region in the province of New Brunswick. PARTICIPANTS Six men and 9 women cancer patients and survivors. METHOD Fifteen adults interviewed when between the ages of 20 and 43 representing a variety of cancers and stages of disease were recruited for this study. Interviews were guided by a set of open-ended questions and explored participants' experiences with cancer from initial presentation of symptoms through to survivorship issues. MAIN FINDINGS The most important clinical issue that emerged from the analysis was that participants' youth appeared to contribute to delays in diagnosis of cancer. These delays were attributed to either patients' or physicians' inaction. Some patients attributed their initial cancer symptoms to the adverse effects of alcohol or excessive partying; others feared a bad diagnosis and delayed seeking help. Family physicians frequently interpreted nonspecific symptoms as resulting from patients' lifestyle choices and were reluctant to consider a diagnosis of cancer. Several family physicians reportedly believed that persistent symptoms could not be the result of cancer because patients were too young. CONCLUSION Although cancer is relatively rare in young adults, family physicians need to include it in differential diagnoses. Both patients and physicians tend to minimize cancer symptoms in young adults. Delays in diagnosis might not affect health outcomes, but can cause distress to young adults with cancer.
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Affiliation(s)
- Baukje Bo Miedema
- Dalhousie University Family Medicine Teaching Unit, Dr Everett Chalmers Regional Hospital, Fredericton, NB, Canada.
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Neal RD, Allgar VL. Sociodemographic factors and delays in the diagnosis of six cancers: analysis of data from the "National Survey of NHS Patients: Cancer". Br J Cancer 2005; 92:1971-5. [PMID: 15900296 PMCID: PMC2361785 DOI: 10.1038/sj.bjc.6602623] [Citation(s) in RCA: 178] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
This paper aims to explore the relationship between sociodemographic factors and the components of diagnostic delay (total, patient and primary care, referral, secondary care) for these six cancers (breast, colorectal, lung, ovarian, prostate, or non-Hodgkin's lymphoma). Secondary analysis of patient-reported data from the ‘National Survey of NHS patients: Cancer’ was undertaken (65 192 patients). Data were analysed using univariate analysis and Generalised Linear Modelling. With regard to total delay, the findings from the GLM showed that for colorectal cancer, the significant factors were marital status and age, for lung and ovarian cancer none of the factors were significant, for prostate cancer the only significant factor was social class, for non-Hodgkin's lymphoma the only significant factor was age, and for breast cancer the significant factors were marital status and ethnic group. Where associations between any of the component delays were found, the direction of the association was always in the same direction (female subjects had longer delays than male subjects, younger people had longer delays than older people, single and separated/divorced people had longer delays than married people, lower social class groups had longer delays than higher social class groups, and Black and south Asian people had longer delays than white people). These findings should influence the design of interventions aimed at reducing diagnostic delays with the aim of improving morbidity, mortality, and psychological outcomes through earlier stage diagnosis.
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Affiliation(s)
- R D Neal
- Department of General Practice, North Wales Clinical School, Wales College of Medicine, Cardiff University, Wrexham Technology Park, Wrexham LL13 7YP, Wales, UK.
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Duijm LEM, Groenewoud JH, Jansen FH, Fracheboud J, van Beek M, de Koning HJ. Mammography screening in the Netherlands: delay in the diagnosis of breast cancer after breast cancer screening. Br J Cancer 2004; 91:1795-9. [PMID: 15505630 PMCID: PMC2409760 DOI: 10.1038/sj.bjc.6602158] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
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 >3 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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Affiliation(s)
- L E M Duijm
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands.
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Abstract
UNLABELLED CONDENSED: Among 550 women reporting a lump as the first sign of breast cancer, those with this sign for 6-29 months compared to those with 1-6 months, had bigger tumors and more frequent axillary node involvement. Overall survival, however, was not significantly different in these two groups. BACKGROUND The relationship of delay in diagnosis of breast cancer to survival is uncertain. METHODS We evaluated the relationship of patient-reported duration of signs of breast cancer to survival in participants in a clinical trial of adjuvant hormonal therapy in Vietnam and China. RESULTS Among 550 women reporting a lump as the first sign of breast cancer and information on when this appeared, the median duration of this sign before diagnosis was 6 months. Comparing two groups of patients with durations of lumps 1-6 months and 6-29 months, the group with longer duration of lumps had larger tumors clinically and pathologically (p = 0.0006, and p = 0.004), more frequent axillary node involvement (p = 0.008), and shorter but not statistically different disease-free and overall survival from the time of diagnosis (p = 0.09 and 0.35, respectively). CONCLUSIONS Breast cancer evolves slowly in the detectable period of its natural history. The impact of delays in diagnosis of less than 6 months is likely to be very limited; delays more than 6 months appear to have some, but marginal impact on survival.
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Affiliation(s)
- Richard R Love
- Department of Medicine, Section of Medical Oncology, University of Wisconsin School of Medicine, Madison, WI, USA.
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Abstract
BACKGROUND Delay in the diagnosis of breast cancer has important clinical and medicolegal implications. This study assessed the frequency, causes and effects of delay in the diagnosis of breast cancer in a specialist breast unit. METHODS Details of women who attended the breast clinic between 1988 and 1999 inclusive, and for whom the interval between first attendance and diagnosis of invasive breast cancer was greater than 2 months, were reviewed. Potential causes of delay were identified and the consequence of the delay assessed. The clinical features were compared with those of patients diagnosed with breast cancer during a 2-year period from 1999 and 2001. RESULTS Breast cancer was diagnosed in 5283 women during the interval reviewed; delay in diagnosis was suggested in 72 women (1.4 per cent). Women with a delayed diagnosis were younger (P < 0.001) and had a smaller tumour at diagnosis (P = 0.011) compared with all women diagnosed with breast cancer between 1999 and 2001. There were no differences in the rate of axillary node positivity or the need for mastectomy. Women unsuitable for conservation therapy in the delayed group had a significantly longer interval to diagnosis (P = 0.006). CONCLUSION The likelihood that conservation therapy will be appropriate is reduced when the hospital delay in the diagnosis of breast cancer is more than 240 days. All patients with a palpable mass require triple assessment to minimize delay in diagnosis of breast cancer.
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Affiliation(s)
- M D Barber
- Edinburgh Breast Unit, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
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Lillquist PP. Can case management be used to facilitate diagnostic testing in publicly funded breast cancer screening programs? Soc Work Health Care 2004; 40:55-71. [PMID: 15774363 DOI: 10.1300/j010v40n02_04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The earlier breast cancer can be diagnosed and treated, the better the odds for survival. The literature has shown many of the barriers to timely diagnosis are not individual behaviors but problems in delivery of health care. Case management has been suggested to facilitate diagnostic testing and treatment. Models of case management exist in other practice settings but have not always been rigorously described or evaluated. Determining optimal models for case management has been established federally as a research priority to ensure medically underserved women are promptly diagnosed and treated. One model has been developed and pilot-tested in this setting. This article will describe elements of case management and the characteristics of a publicly funded screening program that make use of case management to facilitate timeliness of diagnostic testing different from case management in other settings. These differences have implications for successfully implementing case management in public programs.
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Affiliation(s)
- Patricia P Lillquist
- New York State Department of Health, Room 565, Corning Tower, Empire State Plaza, Albany, NY 12237, USA.
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Affiliation(s)
- Leonard Berlin
- Department of Radiology, Rush North Shore Medical Center, 9600 Gross Point Road, Skokie, IL 60076, USA.
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Caballero Alcántara JE, Marchal Escalona C, García Penit J, Padilla León M. [Analysis of the delay in surgical treatment of adenocarcinoma of the prostate]. Actas Urol Esp 2003; 27:286-91. [PMID: 12830550 DOI: 10.1016/s0210-4806(03)72922-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The prostate cancer is an important cause of men's mortality in our society. PURPOSE To know the time of delay in to realise the surgical treatment of the prostate cancer. MATERIALS AND METHODS Analysis of 30 cases of patients treated with radical prostatectomy, cuantifying the time of delay in all the periods of the process. RESULTS Appointment in general practitioner-first appointment in urology: 21.7 days. First appointment in urology-biopsy: 22.8. Biopsy-diagnosis: 34.3. Diagnosis-appointment of anesthesiology: 28.5. Anesthesiology-radical prostatectomy: 25.7. CONCLUSIONS There are actions for to reduce the delay in to perform the diagnosis or treatment, where we can act how an improvement plan: to give poblational education in general and information to the patient in particular, to analyze the rules of medical action, to improve the coordination between level, to improve the flexibility in outpatients appointment and time waiting for diagnosis test and treatment, to correct the temporality, to create clinical units of many specialties and to improve the politics of health.
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Freire AX, Benítez S, Briones K, Freire NV. [Duration of the diagnostic process for lung cancer versus other solid tumors at the National Oncology Institute of Ecuador]. Arch Bronconeumol 2003; 39:167-70. [PMID: 12716557 DOI: 10.1016/s0300-2896(03)75351-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the duration of the outpatient diagnostic process for lung cancer in comparison to that of other solid organ tumors/all tumors at the National Oncology Institute-Society to Fight Cancer (ION-SOLCA) of Ecuador. PATIENTS AND METHODS All patients with non-small cell lung cancer (NSCLC) seen between January 1 and December 31, 1995 at the ION-SOLCA, a specialized tertiary care hospital in Guayaquil, Ecuador, were studied. The duration of the patients' diagnostic process was compared to that of other patients with solid organ tumors (1 control per NSCLC patient). DESIGN Retrospective study of health care services to measure the duration of each stage of the diagnostic process for cancer patients at the ION-SOLCA. MEASURES The main variable was the duration of the diagnostic process. The duration of each phase of the process was also recorded. RESULTS Results are given as means ( standard deviations, with standard errors between parentheses). The overall duration of the diagnostic process for all solid organ tumors (lung and others) at the ION-SOLCA was 54.5 days 62.3 (7.6). No differences were detected between the duration of diagnosis for lung and other tumors. The durations of the different phases of diagnosis were as follows: from the first pre-admission contact with the hospital until a visit with a specialist, 12.5 days 11.4 (1.4); from the visit with a specialist until a diagnostic procedure, 33.3 days 57 (7); and from the diagnostic procedure until the pathological diagnosis, 8.7 days 6.9 (0.8). CONCLUSIONS Outpatient evaluation is an inefficient, slow and potentially dangerous process in cases in which the probability of a cancer diagnosis is high. A more interventionist process involving hospital admission may accelerate diagnosis in such cases.
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Affiliation(s)
- A X Freire
- Servicio de Neumología, Terapia Respiratoria y Cuidados Intensivos. The Regional Medical Center. Universidad de Tennessee Health Science Center. Memphis, TN 38163, USA.
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Olivotto IA, Gomi A, Bancej C, Brisson J, Tonita J, Kan L, Mah Z, Harrison M, Shumak R. Influence of delay to diagnosis on prognostic indicators of screen-detected breast carcinoma. Cancer 2002; 94:2143-50. [PMID: 12001110 DOI: 10.1002/cncr.10453] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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 < or = 0.0001), had larger tumors (79.4% vs. 55.9% > 10 mm; P < or = 0.0001), and were more likely to be lymph node positive (33.9% vs. 17.3%; P < or = 0.0001). For delays beyond > 12 to < or = 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 < or = 20, > 20 to < or = 52, > 52 to < or = 104, and > 104 < or = 156 weeks, respectively (p(trend) < or = 0.0001), compared with delays of > 4 to < or = 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 (p(trend) = 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.
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Affiliation(s)
- Ivo A Olivotto
- Screening Mammography Program of British Columbia, British Columbia Cancer Agency, Vancouver British Columbia, Canada
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Yankaskas BC, Schell MJ, Bird RE, Desrochers DA. Reassessment of breast cancers missed during routine screening mammography: a community-based study. AJR Am J Roentgenol 2001; 177:535-41. [PMID: 11517043 DOI: 10.2214/ajr.177.3.1770535] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to have a series of screening mammograms from routine practice, including false-negative results, reviewed by peer community-based experienced radiologists to determine the percentage of these false-negative findings that might be considered detectable. MATERIALS AND METHODS All screening cases for 1997 and 1998 were identified from the Carolina Mammography Registry. Mammographic assessments from community mammography practices were linked with population-based cancer outcomes. The findings of four community-based radiologists who reviewed the mammograms of 339 asymptomatic women were 93 false-negatives, 180 true-negatives, and 66 false-positives. The percentage of false-negative, true-negative and false-positive findings on breast films that reviewers evaluated was determined. The findings of the reviewers were compared with the original interpreting radiologists' assessments. RESULTS The overall breast-specific workup rate by the reviewing radiologists was 21%. The average workup rate for the false-negative findings was 42% (range, 35-51%). Adjusting for the 13% workup rate in the cancer-free breasts, the percentage of false-negative findings that were detectable was estimated to be 29%. CONCLUSION This peer review of screening mammograms from a population-based screening registry estimated a missed detectable cancer rate of 29%. Thus, 71% of cancers missed at screening would not have been worked up by peers in the same community.
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Affiliation(s)
- B C Yankaskas
- Department of Radiology, CB 7515, RRL, 106 Mason Farm Rd., University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7515, USA
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Arndt V, Stürmer T, Stegmaier C, Ziegler H, Dhom G, Brenner H. Socio-demographic factors, health behavior and late-stage diagnosis of breast cancer in Germany: a population-based study. J Clin Epidemiol 2001; 54:719-27. [PMID: 11438413 DOI: 10.1016/s0895-4356(00)00351-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Late-stage diagnosis of breast cancer is associated with poor survival. Identification of individuals at high risk of late-stage diagnosis could be an effective step to reduce breast cancer mortality. We examined the association of socio-demographic factors and health behavior with breast cancer stage in a population-based sample of 380 female breast cancer patients in Saarland, Germany. Overall, 182 women (47.9%) were diagnosed with late-stage (regional or distant) breast cancer. After control for potential confounding by multivariate logistic regression, an increased risk of late-stage diagnosis was observed for older age (OR = 1.8; 95% CI 1.0-3.2), foreign nationality (OR = 3.9; 95% CI 0.7-20.8), living in large households (OR = 1.7; 95% CI 1.0-2.9), non-participation in general health check-up (OR = 1.5; 95% CI 0.9-2.4) and low interest in health care (OR = 1.6; 95% CI 1.0-2.7). The proportion of late-stage cancer was clearly decreased when tumors were detected by screening (OR = 0.4; 95% CI 0.2-0.8). Certain socio-demographic factors and characteristics of health behavior seem to represent independent risk indicators of late-stage diagnosis.
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Affiliation(s)
- V Arndt
- Department of Epidemiology, University of Ulm, 89081 Ulm, Germany
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