Reducing diagnostic delay in breast cancer. Possible therapeutic implications. GIVIO (Interdisciplinary Group for Cancer Care Evaluation) Italy.

Abstract

A detailed examination of the diagnostic process of 1110 newly diagnosed breast cancer patients first seen at 63 Italian general hospitals showed that 36% of them were diagnosed more than 3 months after the appearance of the first symptom. Whereas 17% (108/633) of the women with less than or equal to 3 months delay were Stage III and IV, the corresponding proportion among women with greater than 3 months delay was 32% (101/320), suggesting that 15% of advanced cases can be attributed to diagnostic delay. A 9% gain in survival at 5 years (66% vs. 57%) could be postulated if reported figures on mortality by stage are applied to our patients with less than or equal to 3 months delay compared to those with greater than 3 months. Moreover, examining the two components of delay (first symptom-first visit and first visit-final diagnosis) our data suggest that the potential benefits of timely presentation were, for some patients, cancelled by delays arising in the health care system. Breast self-examination (BSE) was practiced by 34% of the total population, but only 9% did it on a regular monthly basis. Although any type of BSE (regular and irregular) was associated with a smaller primary at presentation, a limited benefit of the procedure in terms of nodal involvement and pathologic stage of disease was evident only among regular BSE performers.