Abstract
BackgroundUnderstanding the factors affecting the mode and timeliness of breast cancer diagnosis is important to optimizing patient experiences and outcomes. The purposes of the study were to identify factors related to the length of the diagnostic interval and assess how they vary by mode of diagnosis: screen or symptom detection.MethodsAll female residents of Alberta diagnosed with first primary breast cancer in years 2004–2010 were identified from the Alberta Cancer Registry. Data were linked to Physician Claims and screening program databases. Screen-detected patients were identified as having a screening mammogram within 6-months prior to diagnosis; remaining patients were considered symptom-detected. Separate quantile regression was conducted for each detection mode to assess the relationship between demographic/clinical and healthcare factors.ResultsOverall, 38 % of the 12,373 breast cancer cases were screen-detected compared to 47 % of the screen-eligible population. Health region of residence was strongly associated with cancer detection mode. The median diagnostic interval for screen and symptom-detected cancers was 19 and 21 days, respectively. The variation by health region, however, was large ranging from an estimated median of 4 to 37 days for screen-detected patients and from 17 to 33 days for symptom-detected patients. Cancer stage was inversely associated with the diagnostic interval for symptom-detected cancers, but not for screen-detected cancers.ConclusionSignificant variation by health region in both the percentage of women with screen-detected cancer and the length of the diagnostic interval for screen and symptom-detected breast cancers suggests there could be important differences in local breast cancer diagnostic care coordination.
Highlights
Understanding the factors affecting the mode and timeliness of breast cancer diagnosis is important to optimizing patient experiences and outcomes
Study population A retrospective breast cancer cohort of female residents of Alberta, who were diagnosed with a histologically confirmed first-ever primary breast cancer (International Classification of Disease for Oncology (ICD-O) 3rd edition code C50 behaviors 2 and 3 [12]) in years 2004 to 2010, was identified from the Alberta Cancer Registry, a population based cancer registry recognized for data completeness by the North American Association of Central Cancer Registries
Mode of diagnosis There were 12,813 first-ever female breast cancers diagnosed in Alberta residents in years 2004 to 2010; 440 (3.4 %) were excluded from the study because of missing data that prevented the assignment of detection mode
Summary
Understanding the factors affecting the mode and timeliness of breast cancer diagnosis is important to optimizing patient experiences and outcomes. Regardless of the mode of detection, timely diagnostic resolution following detection of breast abnormalities is important. Diagnostic delays of three months or more in symptom-detected breast cancer are associated with a 12 % lower 5-year survival compared to those with shorter delays [10]. Given the public health impact of breast cancer and the value of early detection and timely diagnosis, it is important to understand factors related to timely breast cancer diagnosis and the relationship between mode of diagnosis and diagnostic interval to optimize the patient care experience and, survival of breast cancer patients
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