Abstract
Many women with symptoms suggestive of a breast cancer diagnosis delay presentation to their family physician. Although factors associated with delay have been well described, there is a paucity of data on strategies to mitigate delay. We conducted a qualitative research project to examine factors related to delay and to identify health care system changes that might encourage earlier presentation. Individual semi-structured interviews were conducted with women who sought care 12 weeks or more after self-detection of breast cancer symptoms and with family physicians whose practices included patients meeting that criterion. The women and physicians both suggested a need for clearer screening mammography guidelines for women 40-49 years of age and for better messaging concerning breast awareness. The use of additional hopeful testimonials from breast cancer survivors were suggested to help dispel the notion of cancer as a "death sentence." Educational initiatives were proposed, aimed at both increasing awareness of "non-lump" breast cancer symptoms and advising women that a previous benign diagnosis does not ensure that future symptoms are not cancer. Women wanted empathic nonjudgmental access to care. Improved methods to track compliance with screening mammography and with periodic health exams and access to a rapid diagnostic process were suggested. A list of "at-risk situations for delay" in diagnosis of breast cancer was developed for physicians to assist in identifying women who might delay. Health care system changes actionable both at the health policy level and in the family physician's office were identified to encourage earlier presentation of women with symptomatic breast cancer.
Highlights
Despite extensive measures to promote early detection of breast cancer, an estimated 20%–30% of women will wait at least 3 months before seeking help for breast cancer symptoms [1,2]
Educational initiatives were proposed, aimed at both increasing awareness of “non-lump” breast cancer symptoms and advising women that a previous benign diagnosis does not ensure that future symptoms are not cancer
A list of “at-risk situations for delay” in diagnosis of breast cancer was developed for physicians to assist in identifying women who might delay
Summary
Despite extensive measures to promote early detection of breast cancer, an estimated 20%–30% of women will wait at least 3 months before seeking help for breast cancer symptoms [1,2]. In quantitative and qualitative studies to date, a number of potential risk factors for delayed presentation of breast cancer have been identified [1,2,4,7,8,9,10,11,12,13,14,15,16,17,18,19], including older age at diagnosis 4, fear of cancer [11,13,14], symptom other than a breast lump [2,9,10,14], competing life demands 13, belief in alternative therapies [13,14,15,16,17,18,19], lower level of education 17, spiritual beliefs [17,19], and African American or Hispanic descent 17. Factors associated with delay have been well described, there is a paucity of data on strategies to mitigate delay
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