Abstract
IntroductionMost symptomatic women with breast cancer have relatively short diagnostic intervals but a substantial minority experience prolonged journeys to diagnosis. Atypical presentations (with symptoms other than breast lump) may be responsible. MethodsWe examined the presenting symptoms of breast cancer in women using data from a national audit initiative (n=2316). Symptoms were categorised topographically. We investigated variation in the length of the patient interval (time from symptom onset to presentation) and the primary care interval (time from presentation to specialist referral) across symptom groups using descriptive analyses and quantile regression. ResultsA total of 56 presenting symptoms were described: breast lump was the most frequent (83%) followed by non-lump breast symptoms, (e.g. nipple abnormalities (7%) and breast pain (6%)); and non-breast symptoms (e.g. back pain (1%) and weight loss (0.3%)).Greater proportions of women with ‘non-lump only’ and ‘both lump and non-lump’ symptoms waited 90days or longer before seeking help compared to those with ‘breast lump only’ (15% and 20% vs. 7% respectively). Quantile regression indicated that the differences in the patient interval persisted after adjusting for age and ethnicity, but there was little variation in primary care interval for the majority of women. ConclusionsAbout 1 in 6 women with breast cancer present with a large spectrum of symptoms other than breast lump. Women who present with non-lump breast symptoms tend to delay seeking help. Further emphasis of breast symptoms other than breast lump in symptom awareness campaigns is warranted.
Highlights
Most symptomatic women with breast cancer have relatively short diagnostic intervals but a substantial minority experience prolonged journeys to diagnosis
Informed by the principles of natural language processing (NLP), free-text descriptions were coded into symptoms without using any prior construct definitions or restrictions [24]
Concordant with international consensus statements, the patient interval was defined as the number of days between symptom onset and the first presentation, and the primary care interval as the number of days between first presentation and the first specialist referral [27]
Summary
Most symptomatic women with breast cancer have relatively short diagnostic intervals but a substantial minority experience prolonged journeys to diagnosis. Breast lump is the most common presenting symptom among women with breast cancer and has relatively high predictive value for malignancy [1,2] It has long been the focus of public health education campaigns about cancer symptom awareness [3,4]. Koo et al / Cancer Epidemiology 48 (2017) 140–146 may attribute non-lump breast symptoms to other non-malignant causes such as hormonal changes, trauma, or breastfeeding [15,16,17] While this provides an explanation of why some women may experience long intervals to presentation, there has been limited examination of diagnostic timeliness using population-based studies and large representative samples of women with breast cancer. Existing studies often dichotomise presenting symptoms based on the presence or absence of breast lump, limiting the appreciation of the large spectrum of presenting symptoms within the ‘non-lump’ breast symptoms category [18,19,20,21]
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