Delay in presentation of symptomatic referrals to a breast clinic: patientand system factors

We attempted to identify factors associated with delay in presentation and assessment of women with breast symptoms who attended a London breast clini c. A total of 692 consecutive symptomatic referrals, aged 40-75 years, were studied. Patient delay, assessed prior to diagnosis, was defined as time e lapsing between symptom discovery and first presentation to a medical provi der. This was studied in relation to: reasons for delaying, beliefs and att itudes, socio-demographic and clinical variables, psychiatric morbidity and subsequent diagnosis. Thirty-five per cent of the cohort delayed presentat ion 4 weeks or more (median 13 days). The most common reason given was that they thought their symptom was not serious (odds ratio (OR) = 5.32, 95% co nfidence interval (CI) 3.6-8.0). Others thought their symptom would go away (OR = 3.73, 95% CI 2.2-6.4) or delayed because they were scared (OR = 4.61 , 95% CI 2.1-10.0). Delay was associated with psychiatric morbidity but not age. Patients who turned out to have cancer tended to delay less (median 7 days) but not significantly. Median system delay - time between first medi cal consultation and first clinic Visit - was 18 days. Patients who thought they had cancer and those so diagnosed were seen more promptly (median 14 days). Most factors, including socio-economic status and ethnicity were non -contributory. Beliefs about breast symptoms and their attribution are the most important factors determining when women present. Health education mes sages should aim to convince symptomatic women that their condition require s urgent evaluation, without engendering fear in them. (C) 2000 Cancer Rese arch Campaign.