Abstract
IntroductionAlthough prognostic differences between screen-detected, interval and symptomatic breast cancers are known, factors associated with wait times to diagnosis among these three groups have not been studied.MethodsOf the 16,373 invasive breast cancers diagnosed between January 1, 1995 and December 31, 2003 in a cohort of Ontario women aged 50 to 69, a random sample (N = 2,615) were selected for chart abstraction. Eligible women were classified according to detection method; screen-detected (n = 1181), interval (n = 319) or symptomatic (n = 406). Diagnostic wait time was calculated from the initial imaging or biopsy to breast cancer diagnosis. Logistic regression analysis examined associations between diagnostic wait times dichotomized as greater or less than the median and demographic, clinical and prognostic factors separately for each detection cohort.ResultsWomen who underwent an open biopsy had significantly longer than median wait times to diagnosis, compared to women who underwent a fine needle aspiration or core biopsy; (screen-detected OR = 2.76, 95% CI = 2.14-3.56; interval OR = 2.56, 95% CI = 1.50-4.35; symptomatic OR = 5.56, 95% CI = 3.33-9.30). Additionally, screen-detected breast cancers diagnosed with stage II and symptomatic cancers diagnosed at stage III or IV had significantly shorter diagnostic wait times compared to those diagnosed at stage 1 (OR = 0.66 95% CI = 0.50-0.87 and OR = 0.46, 95% CI = 0.25-0.85 respectively).ConclusionsOur study is consistent with expedited diagnostic work-up for breast cancers with more advanced prognostic features. Furthermore, women who had an open surgical biopsy had a greater than the median diagnostic wait time, irrespective of detection method.
Highlights
Prognostic differences between screen-detected, interval and symptomatic breast cancers are known, factors associated with wait times to diagnosis among these three groups have not been studied
A study of women with abnormalities detected through Canadian screening programs reported longer median waiting times for a diagnosis when an open biopsy was performed; wait times were shorter for programs that used core biopsies more often (Olivotto et al 2001)
The purpose of this study is to identify demographic, clinical and prognostic factors associated with median diagnostic wait times separately for each cohort by detection method
Summary
Prognostic differences between screen-detected, interval and symptomatic breast cancers are known, factors associated with wait times to diagnosis among these three groups have not been studied. Several studies have found that among women with screendetected breast cancer, those with “high-suspicion” compared to “low suspicion” screening mammograms had shorter diagnostic intervals (Olivotto et al 2002; Ganry et al 2004; Caplan et al 2000). A study of women with abnormalities detected through Canadian screening programs reported longer median waiting times for a diagnosis when an open biopsy was performed; wait times were shorter for programs that used core biopsies more often (Olivotto et al 2001). The purpose of this study is to identify demographic, clinical and prognostic factors associated with median diagnostic wait times separately for each cohort (screen-detected, interval and symptomatic) by detection method
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