Terminology and Details of the Diagnostic Process for Testis Cancer

Abstract

We examined the process and causes of diagnostic delay, defined as the interval from symptom onset to diagnosis, for testis (germ cell) cancer and the change with time. Diagnostic delay influences disease burden and may be subdivided into symptomatic interval, defined as symptom onset to first presentation, and diagnostic interval, defined as first presentation to diagnosis. We performed a single center review of 100 consecutive cases. Diagnostic delay in weeks, and symptomatic and diagnostic intervals in days were calculated, and related factors were recorded. Previous reports by the senior author (JT) in the same health care system allowed the examination of change during 2 decades. Mean±SD diagnostic delay was 12.5±17.4 weeks (median 6, range 1 to 104), a substantial decrease in the mean of 10 months reported by one of us (JT) in 1987. Mean symptomatic interval was 65.4±100.9 days (median 29, range 0 to 720). Mean diagnostic interval was 21.9±63.5 days (median 7, range 1 to 540). Symptomatic interval exceeded or was equal to diagnostic interval in 80 men. This terminology allows detailed examination of the diagnostic process for testis cancer. Aberrant diagnostic delay for testis cancer is decreasing and is now dominated by patient dependent factors. Select cases suggest that physician error remains a factor in a minority.