Determinant factors for diagnostic delay in operable breast cancer patients

Randomized trials of mammographic screening have provided strong evidence t hat early diagnosis and treatment of breast cancer can reduce the specific mortality. Moreover, in a recent systematic review of published studies, de lays of 3-6 months between symptom onset and treatment have been clearly fo und to be associated with lower survival rates for breast cancer patients. The aim of this study was to examine delays registered among breast cancer patients in southern Italy, in order to recognize their determining factors so as to provide women with a better opportunity for survival. The variabl es examined were age (< 50, 50-64, <greater than or equal to> 65 years), ed ucation (less than or equal to5, > 5 school years); symptom status at first presentation (symptomatic or asymptomatic); date of first symptom presenta tion; date of first consultation with a health provider; the type of health provider consulted; tumour size and nodal status according to the pTNM sys tem. Time intervals were categorized into: <1 month, 1-3 months and > 3 mon ths for patient and medical delay; 1-3 months, 3-6 months, > 6 months for o verall delay. Patient delay was associated with age and education: a higher risk was found for women of over 65 years age (odds ratio (OR) 2.1, 95% co nfidence interval (CI) 1.2-3.5) and with less than or equal to5 years schoo l attendance (OR 3.3, 95% CI 2.0-5.6). Medical delay was seen to be associa ted with the professional figure: significant differences were found betwee n senologists (oncologists exclusively dedicated to breast cancer operation ) and other specialists (OR 3.5, 95% CI 1.5-8.4). Young age and symptomatic presentation were found to be high risk factors. Concerning tumour size in overall delay, in cases where the tumour was >2 cm the OR was 2.4 (95% CI 1.5-3.7). Our study suggests that diagnostic delay can be reduced by provid ing more efficient training programmes for members of the medical professio n and by producing educational training programmes targeted specifically at each age category (i.e. in older women more attention to education in prev ention; in younger women correct information about mammography and speciali zed structures). (C) 2001 Lippincott Williams & Wilkins.