Abstract
Delays in diagnosing breast cancer (BC) can lead to poorer outcomes. We investigated factors related to the diagnostic interval in a population-based cohort of 3202 women diagnosed with BC in Queensland, Australia. Interviews ascertained method of detection and dates of medical/procedural appointments, and clinical information was obtained from medical records. Time intervals were calculated from self-recognition of symptoms (symptom-detected) or mammogram (screen-detected) to diagnosis (diagnostic interval (DI)). The cohort included 1560 women with symptom-detected and 1642 with screen-detected BC. Symptom-detected women had higher odds of DI of >60 days if they were Indigenous (OR = 3.12, 95% CI = 1.40, 6.98); lived in outer regional (OR = 1.50, 95% CI = 1.09, 2.06) or remote locations (OR = 2.46, 95% CI = 1.39, 4.38); or presented with a “non-lump” symptom (OR = 1.84, 95% CI = 1.43, 2.36). For screen-detected BC, women who were Indigenous (OR = 2.36, 95% CI = 1.03, 5.80); lived in remote locations (OR = 2.35, 95% CI = 1.24, 4.44); or disadvantaged areas (OR = 1.69, 95% CI = 1.17, 2.43) and attended a public screening facility (OR = 2.10, 95% CI = 1.40, 3.17) had higher odds of DI > 30 days. Our study indicates a disadvantage in terms of DI for rural, disadvantaged and Indigenous women. Difficulties in accessing primary care and diagnostic services are evident. There is a need to identify and implement an efficient and effective model of care to minimize avoidable longer diagnostic intervals.
Highlights
An estimated 1.67 million women were diagnosed with breast cancer worldwide in 2012 and rates are continuing to rise [1]
Just under half were diagnosed with stage I breast cancer (48.6%), 38.8% with stage II, 11.1% with stage
We found shorter time intervals in notification of results for women whose mammogram was conducted at a private facility, with the majority of those women being notified within two days
Summary
An estimated 1.67 million women were diagnosed with breast cancer worldwide in 2012 and rates are continuing to rise [1]. In Australia, breast cancer is the most common cancer diagnosed amongst women (with the exception of keratinocyte cancer) and the second leading cause of cancer death [2]. Detection of breast cancer at an early stage is associated with lower mortality and improved survival [3]. Observed five-year survival varies from 88% for stage I breast cancers to 15% for stage. The goal is always to diagnose cancers at the earliest possible stage providing patients with the best possible prognosis. The majority of adult cancers are slow growing, with one study suggesting breast cancers were diagnosed, on average, approximately seven years after the initial onset [5]
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