In-hospital delay in the diagnosis of breast cancer

Background: There is evidence that delay in the diagnosis of breast cancer may prejudice survival. The aim of this study was to determine the incidenc e, time trends and causes of delay in a dedicated breast clinic. Methods: The interval between first breast clinic visit and a definitive di agnosis was recorded in all patients with invasive breast cancer between 19 88 and 1997. In all patients with a delay of 3 months or more, the case not es were reviewed for evidence of a triple assessment (clinical examination, imaging and needle biopsy). The principal cause of delay was identified. Results: Of 1004 patients with invasive breast cancer, there was a delay in diagnosis of 3 months or more in 42 patients between 1988 and 1997, an inc idence of 4.2 per cent. The median delay was 6 months and the median age at diagnosis was 53 (range 27-89) years. Triple assessment was undertaken in 30 patients; ten did not have a needle biopsy performed and three patients had no mammography. The principal cause of delay was: false-negative or ina dequate fine-needle aspiration cytology (FNAC) in 19 patients, failure of f ollow-up in eight, clinical signs did not impress in five, FNAC not carried out in four, false-negative mammogram in three, failure of needle localiza tion in two and one patient did not accept clinical advice. The annual inci dence of delay in diagnosis did not change significantly over the 10-year i nterval. Conclusion: Triple assessment is not sufficiently sensitive to detect every breast cancer and a small incidence of diagnostic delay is therefore inevi table with current techniques.