Diagnosis and treatment delay in gynecological malignancies. Does it affect outcome?

Delay of diagnosis and treatment of malignant tumors is perceived as unfavo rably affecting outcome. However, tumor behavior may be determined early in the histogenesis process and the outcome may be more a function of the bio logic properties of the tumor than of our ability to make an early diagnosi s. The objective of the present review is to evaluate data concerning the e ffect of diagnosis and treatment delay on outcome in gynecological malignan cies. A medline search including the terms diagnosis delay, treatment delay , outcome, vulvar carcinoma, cervical carcinoma, endometrial carcinoma and ovarian carcinoma was conducted and all pertinent articles in the English l anguage were included. Relatively few investigations deal with the effect o f diagnosis and treatment delay on prognostic factors and on outcome in inv asive gynecological malignancies. The reviewed data do not seem to indicate an unequivocal deleterious effect of a delay of several weeks or even seve ral months in patients with some gynecological malignancies. Intentional de lay of diagnosis or treatment of gynecologic malignancies is unjustified; h owever, the data presented should encourage a closer scrutiny and possibly a revision of the concept of "early" diagnosis and of the notion that delay of any duration has a definite, unfavorable effect on outcome.