Breast Cancer Diagnostic Delays in Young Mexican Patients Are Associated With Lack of Suspicion by Healthcare Providers at First Presentation

Abstract

Background: Breast cancer (BC) is the leading cause of cancer-related mortality in women between 20 and 40 years of age. Younger patients are more likely to be diagnosed in advanced clinical stages in comparison with their older counterparts. This has been explained by 2 possible mechanisms: 1) more aggressive tumor behavior that leads to faster cancer growth and dissemination, and 2) greater delays in confirming cancer diagnosis among younger women. However, there is conflicting evidence regarding the association between young age and a longer diagnostic interval of care. Aims: This study aimed to determine whether there is an association between the patient's age and the length of the diagnostic interval of care, and to identify the mechanisms that might explain this association. Methods: We surveyed 708 patients that received a new BC diagnosis between 06.01.16 and 05.31.17 in the 2 largest public hospitals in Mexico City for uninsured patients. All patients signed informed consent. Patients' medical files were reviewed. We gathered data on: dates for estimation of the diagnosis interval (first medical consultation and diagnosis confirmation), sociodemographic characteristics, form of BC identification (symptoms vs screening) and health service utilization variables. The 589/708 (83%) patients who identified their BC through self-detection were included in the final analysis. We adjusted Cox regression models to assess the relationship between age and the length of the diagnosis interval. Results: 110/589 (18%) participants were 40 years old or younger. Young age was significantly associated with longer diagnosis intervals of care after controlling by education, occupation, health insurance status, type of first health care services used, specialty of the first doctor consulted, first imaging study result, number of breast imaging studies, and transportation time from residence to hospital. The risk of 1 additional day between first medical consultation and diagnostic confirmation was increased by 1% for each year of less age (HR = 1.01, P = 0.003). The significant association between age and diagnosis delay was lost when adding to the model the following variables: first medical diagnostic impression (as perceived by the patient), number of health services used and number of consultations previous to arrival to the cancer hospital. Conclusion: Our results confirm that the younger a patient, the higher the risk of experiencing delays on the diagnostic interval. Additionally, these findings suggest that delays in public services available for the uninsured in Mexico are related to medical errors at first presentation and, consequently, the need of using different services and having multiple consultations before a BC diagnosis can be ascertained. To enhance earlier diagnosis it is imperative that healthcare providers are aware of the burden of BC in young women, and not automatically discard this diagnostic possibility because of young age.