Breast Cancer Diagnostic Delays Among Young Mexican Women Are Associated With a Lack of Suspicion by Health Care Providers at First Presentation.

Abstract

PURPOSEThere is insufficient evidence in the literature regarding the association between young age and diagnostic delay of breast cancer (BC). This study aimed to determine whether young age increases the risk of diagnostic delays among patients with BC and also to identify the mechanisms through which young age affects diagnostic delay.CONTEXTKey ObjectiveThis study aimed to determine if young age increases the risk of diagnostic delays among patients with breast cancer and also to identify the mechanisms through which young age affects diagnostic delay. A cross-sectional study of 592 patients with symptomatic breast cancer treated at two of the largest public cancer hospitals in Mexico City was performed.Knowledge GeneratedParticipants 40 years of age or younger had significantly longer diagnostic intervals and presented with more advanced cancers than did their older counterparts. Young age increased the risk of diagnostic delays through an increased risk of lack of cancer suspicion at the first health care service consulted.RelevanceIt is of the uttermost importance to improve cancer awareness among primary health care providers working in the public system so that they avoid discarding a cancer diagnosis solely on the basis of the patient’s age.PATIENTS AND METHODSThis was a cross-sectional study of 592 patients with symptomatic BC treated at two of the largest public cancer hospitals in Mexico City available for the uninsured and those covered by Seguro Popular. A validated questionnaire was administered via face-to-face interviews with the patients, and their medical files were reviewed. Path analyses, using multivariable logistic regression models, were conducted to assess the relationship between age and diagnostic delay, as well as the role of potential confounders.RESULTSYounger participants (40 years of age or younger) had significantly longer diagnostic intervals and presented with more advanced cancer stage than did their older counterparts. Younger participants more often sought initial health care in private services led by gynecologists, more frequently experienced a lack of cancer suspicion by the first physician they consulted, used a higher number of different health services, and had more medical consultations before arrival to a cancer care center. Younger age was significantly associated with longer diagnostic delays after controlling for education, occupation, lack of health insurance, history of benign breast conditions, type of first health service used, specialty of the first physician consulted, first symptom presented, and benign interpretation of the first breast image study.CONCLUSIONYoung age increased the risk of diagnostic delays, which seems to be a result of an increased risk of lack of cancer suspicion at the first health care service consulted.