Delay In Diagnosis Of Breast Cancer Research Articles

Influence of health insurance type on time to breast cancer diagnosis and treatment among members of a large national payor.

e23049 Background: Delays in breast cancer diagnosis and treatment can decrease early screening benefits. This study investigates the relationship between health insurance type and time from cancer screening to biopsy and biopsy to treatment initiation in members of a national health plan diagnosed with breast cancer. Methods: De-identified administrative records of Medicare, Medicaid and Commercial fully insured (C-FI) members with a claim for breast cancer between January 2020 and December 2022 were retrospectively analyzed. Poisson regression modeling determined duration (days) from screening to biopsy and biopsy to treatment initiation by insurance type group controlling for covariates. Between-group differences in duration were estimated by exponentiating the model estimate and converting to a percentage change, which was then applied to the mean days to event. P< 0.05 was considered significant. Results: 29,731 members (C-FI: 5,256; Medicare: 22,304; Medicaid: 2,171) with a diagnosis of breast cancer were evaluated. Mean duration from screening to biopsy was 21.5 days (95% confidence interval [CI]: 20.9-22.0). Insurance type was associated with time from screening to biopsy. Compared to C-FI members, Medicaid members experienced a longer duration between screening and biopsy by +12.6 days (95% CI: 11.7-13.6; P< 0.0001). Compared to C-FI members, Medicare members received biopsies 3.4 days sooner (95% CI: 3.0-3.8; P< 0.0001). Mean duration from biopsy to treatment was 35.4 days (95% CI: 34.9-35.9) with similar differences by insurance type. Compared to C-Fl members, Medicaid members experienced a longer duration between biopsy and treatment by +7.9 days (95% CI: 6.9-9.0; P< 0.0001). Compared to C-FI, Medicare members received treatment 3.6 days sooner (95% CI: 3.0-4.1; P< 0.0001). Conclusions: Health insurance type appears to impact time from breast cancer screening to biopsy and treatment initiation. Medicaid members may experience longer duration for both time from screening to biopsy and biopsy to treatment. Future studies will explore if these variations translate to clinically meaningful health outcomes and identify opportunities to provide additional support for individuals experiencing breast cancer.

Abstract PO3-10-11: Mujeres Avanzando a la Sobrevida (MAS: women going forward in survival): Breast Cancer Characteristics and Delays in Care in Honduras

Abstract Introduction: Low and middle-income countries have exceedingly high breast cancer mortality rates primarily due to delays to diagnosis and treatment. The Breast Health Global Initiative (BHGI) recommends a diagnostic interval (time from initial provider visit to receiving a diagnosis) of < 60 days. Honduras is one of the poorest countries in the western hemisphere and has a paucity of published breast cancer research. Our objective was to understand delays in breast cancer diagnosis and treatment in Honduras. Methods: We initiated a prospective cohort study (Mujeres Avanzando a la Sobrevida (MAS: Women Going Forward in Survival)) in 2021 at two hospitals in two major cities in Honduras. All patients with newly diagnosed breast cancer were invited to participate. We prospectively collected demographic, cancer, and treatment data through patient interviews and surveys. We also determined several time intervals including: onset of symptoms to initial provider visit (patient interval), initial provider visit to biopsy (diagnostic interval), and biopsy to first treatment (treatment interval). Patients also completed the Unger-Saldana Delay Survey to assess their perceptions of any delays in cancer care and reasons for these delays. Results: We enrolled 95 patients with an average age of 54 years. 73% of patients reported an income of < 1 minimum wage (< 8,448 lempiras/month). 93% were housewives, and 35% were married. The majority of patients had an elementary school education or no education (61%). The most common first symptom was a breast lump (81%). The majority of patients had advanced stage disease (Stage III and IV: 64%). The mean patient interval was 185 days. The mean diagnostic interval was 153 days, and the mean treatment interval was 139 days. Most patients (61%) thought their symptoms were slightly serious or not serious at all, and 78% did not think their symptoms were due to cancer. Most patients (60%) thought they were able to see a physician immediately or soon after symptoms developed (63%). Patient stated reasons for not seeking care earlier included believing their symptoms would self-improve, being unsure which health service to go to, lack of money, and fear. Similarly, most patients (67%) thought the time between seeing their first provider and visiting the cancer hospital was immediate or soon but not immediately. Reasons for this delay included lack of information, lack of money, wait times to appointment or tests, incorrect initial diagnosis, and fear. Conclusion: In this prospective cohort study, nearly two-thirds of patients in Honduras were diagnosed with stage III/IV breast cancer. We found marked delays in patient, diagnostic, and treatment intervals, even though patients perceived their care to be immediate. Importantly, the diagnostic interval far exceeded 60 days, as recommended by the BHGI. This study provides initial insight into delays in breast cancer care in Honduras and provides an opportunity to target obstacles to early diagnosis and treatment and to improve breast cancer survival. Citation Format: Saranya Prathibha, Alejandra Molina, Jorge Siryi, Kristhel Gaitán, Mildred Raudales, Manuel Maldonado, Todd Tuttle, Suyapa Bejarano. Mujeres Avanzando a la Sobrevida (MAS: women going forward in survival): Breast Cancer Characteristics and Delays in Care in Honduras [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-10-11.

Relationship between Delayed Breast Cancer Diagnosis and Behavioral Economic Factors and Personality Characteristics.

Delays in breast cancer diagnosis can allow the disease to progress to an incurable stage. However, factors that cause patients to delay seeking treatment are unclear. In this study, we aimed to identify behavioral economic factors and personality characteristics of patients with breast cancer who had a delayed diagnosis. We analyzed questionnaires completed by 41 patients with breast cancer. A delayed diagnosis was defined if the time between the first symptom and the medical visit was more than 6 months. We found 11 patients who had a delayed diagnosis. The significant characteristics associated with patients with breast cancer who had delayed diagnosis were: (i) less experience with breast cancer screening; (ii) progressive disease stage; and (iii) low time and future time preference. We found no significant behavioral economic factors other than time preference, and personality that differed between patients with breast cancer who did and did not have a delayed diagnosis. Low time preference rate is a characteristic of patients with breast cancer who had a delayed diagnosis.

Association of Delay in Breast Cancer Diagnosis With Survival in Addis Ababa, Ethiopia: A Prospective Cohort Study.

There are limited data on the association between delay in breast cancer diagnosis after breast symptom recognition and survival, particularly in sub-Saharan Africa. The recently launched Global Breast Cancer Initiative by WHO includes measuring delay as the core indicator for quality of breast cancer care. Herein, we examined the association between delay in breast cancer diagnosis with overall survival among women in Addis Ababa, Ethiopia. A total of 439 women diagnosed with breast cancer from January 1, 2017, to June 30, 2018, in Addis Ababa were followed for survival to the end of 2019. Survival rates were estimated using the Kaplan-Meier method. The association between delay in diagnosis (>3 months after symptom recognition) and overall survival was computed using the multivariable Cox regression model after adjusting for demographic and clinical factors. Nearly 70% (303/439) of women with breast cancer were delayed in diagnosis of their cancer. During a median follow-up period of 25.1 months, 2-year overall survival rate was 73.5% (95% CI, 68.0 to 78.2) in women with diagnosis delay compared with 79.1% (95% CI, 71.2 to 85.1) in those women without diagnosis delay. In the multivariable Cox regression model, the risk of death was 73% higher (hazard ratio, 1.73; 95% CI, 1.09 to 2.74) in women with diagnosis delay compared with those without diagnosis delay. Delay in diagnostic confirmation of breast cancer after recognition of breast symptoms was negatively associated with overall survival in Addis Ababa, Ethiopia, underscoring the need to increase awareness about the importance of prompt presentation for clinical evaluation and referral for diagnostic confirmation to mitigate the undue high burden of the disease.

Causes and consequences of delayed diagnosis in breast cancer screening with a focus on mammographic features and tumour characteristics

PurposeTo study the prevalence, causes and consequences of delayed breast cancer diagnosis in the screening population. MethodsThis retrospective study was performed in women who underwent biennial screening mammography between January 1, 2009 and June 30, 2019. Patients were divided into 3 groups; screen-detectedbreast cancer (SDC) without a diagnostic delay, a primary diagnostic delay(i.e. missed cancer at previous screening round)and a delay in diagnostic work-up after recall. Women with a true interval cancer (IC; i.e. not visible on prior examinations) were excluded. Outcome parameters included mammographic and tumour characteristics, lymph node status and surgical treatment. ResultsIn our sample of 4491 women with breast cancer (4292 SDC and 199 ‘missed’ IC), respectively, a total of 1112 women experienced a diagnostic delay of ≥ 4 months. Compared to women without a diagnostic delay (n = 2720), the 176 women with a delay in diagnostic work-up showed overall similar mammographic abnormalities (P = 0.052). These groups show similar distributions in invasive tumours, tumour stage and lymph node status (P = 0.25, P = 0.95 and P = 0.93, respectively). Women with a primary diagnostic delay (n = 936) showed less calcifications (P < 0.001), and more masses with calcifications and architectural distortions on mammography (P = 0.01 and P = 0.04, respectively). Moreover, this group comprised larger tumours (P < 0.001) and lymph node metastases (P < 0.001), and more often underwent mastectomy (P < 0.001). ConclusionsA primary diagnostic delay in breast cancer diagnosis results in less favourable tumour characteristics and relatively more mastectomies compared to no delay in breast cancer diagnosis and a delay in diagnostic work-up after recall.

Effectiveness of an Educational Program on Awareness of Breast Cancer Risk Factors, Symptoms, and Barriers to Seeking Medical Help among Adolescent Omani School Students—An Interventional Study

Women in Oman and low- and middle-income countries (LMICs) are usually diagnosed with BC at a younger age and more advanced stage, with poor five-year survival. This study aims to evaluate the effectiveness of breast cancer (BC) related educational programs among female Omani adolescents. Six female-only public schools were randomly selected from three governorates of Oman and assigned to the control or interventional group. An Arabic version of the Breast Cancer Awareness Measure questionnaire was used to evaluate students attending grades 10 and 11 at baseline (T0) and after 4 weeks (T1). After T0, the intervention group participated in a one-hour BC education program involving group discussions, a slideshow presentation, leaflets, and online access to program materials and videos. Non-parametric tests were used to compare scores between intervention and control groups and within each group across time (T0 vs. T1). A total of 1106 students participated, of which 547 (49.5%) and 559 (50.5%) were allocated to the control and intervention groups, respectively. Recognition of BC risk factors (Z = 18.67; p < 0.001) and symptoms (Z = 20.01; p < 0.001) increased significantly in the intervention group between T0 and T1 and compared to the control group at T1 (U = 27.27; p < 0.001, and U = 25.75; p < 0.001, respectively). Anticipated time to seeking medical help (Z = 18.67; p < 0.001) and barriers to help-seeking (Z = 7.91; p < 0.001) decreased significantly between T0 and T1 in the intervention group and compared to the control group at T1 (U = 15.78; p < 0.001, and U = 3.44; p = 0.001, respectively). The program increased knowledge of BC risk factors and symptoms and promoted early medical help-seeking among Omani female adolescents. Healthcare strategic planners and policy-makers in Oman and low- and middle-income countries should consider incorporating cancer education programs in the national school curriculum to minimize delays in BC diagnosis and improve the survival rate.

The Impact of Social Determinants of Health on the Time Between Diagnostic Breast Imaging and Biopsy at a Safety Net Hospital.

Although social determinants of health (SDH) are thought to be associated with health outcomes, there is limited literature on the direct impact of SDH on delays in breast cancer diagnosis via breast imaging. Identifying SDH associated with longer lapses (defined in this study as a time interval between two events) between imaging and biopsy is essential to early-stage detection of breast cancer, which has a significant impact on survival. Previous work demonstrated associations between both housing and food insecurity with longer lapses between diagnostic imaging and biopsy. We aim to expand upon this retrospective analysis with a longer study period, more participants, and improved data cleaning techniques to better understand how SDH may affect the lapse between imaging and biopsy. This retrospective study was institutional review board approved and HIPAA compliant. Informed consent was waived. Patients who underwent screening mammography between January 1, 2015, and January 1, 2020, were assessed for timing of recommended biopsy due to a BI-RADS category 4 or 5. SDH were assessed with the unique Tool for Health & Resilience in Vulnerable Environments screening questionnaire developed at Boston Medical Center. Associations between imaging and biopsy timing and eight explanatory SDH variables (food insecurity, housing insecurity, ability to pay for medications, transportation access, ability to pay for utilities, caretaking needs, employment, and desire for more education) were assessed with multivariate Cox proportional hazard modeling, as well as demographic data. There were 2,885 unique patients who underwent 3,142 unique diagnostic imaging studies and were included in the multivariate analysis. Of those 3,142 imaging studies, 196 (6.2%) had not yet been followed by the recommended biopsy by the end of the study period; 2,271 patients (78.7%) had SDH data in at least one domain; and the individual domains ranged from 962 patients (32.1%) with complete data for education to 2,175 patients (75.4%) with complete data for food insecurity. A positive screen for at least one SDH was associated with a longer lapse between diagnostic imaging and biopsy (P= .048). Furthermore, housing insecurity alone was nearly associated with longer lapses between diagnostic imaging and biopsy (P= .059). Those who desired more education were found to have shorter lapses between diagnostic imaging and biopsy (P= .037). Only a positive screen of the aggregate of all SDH (using a novel tool developed at our safety net hospital) was associated with a statistically significant lengthening of this lapse. Of the eight SDH screened, housing insecurity was the closest to association with longer lapses between diagnostic imaging and biopsy, whereas patients who desired more education were found to have statistically significant shorter lapses; however, this survey domain had the lowest completion rate. Identification of which SDH might affect the time from imaging to biopsy can potentially inform targeted programs to intervene. Government and health system interventions addressing SDH, notably housing insecurity, could allow for shorter time to breast cancer diagnosis and treatment.

Abstract P1-05-32: Outcomes of diagnostic breast imaging in young women (less than 50 years old)

Abstract INTRODUCTION The incidence of breast cancer is on the rise in the younger population, with 23 percent of all breast cancer diagnoses occurring in those under the age of 50. In Canada, screening mammography in women at average risk of breast cancer is recommended after the age of 50. Breast cancer in younger women is biologically more aggressive with greater rates of recurrence and metastatic disease. The sensitivity of mammograms to detect clinical breast abnormalities may be reduced due to increased breast density in this age group, leading to potential delayed diagnosis and poor outcomes. The frequency of false-negative diagnostic mammograms in young women is unknown. The purpose of this study is to describe the outcomes of diagnostic breast imaging in young women undergoing investigations for abnormal clinical breast findings and the frequency of delayed breast cancer diagnosis (more than 6 months after initial diagnostic mammography). METHODS We conducted a retrospective electronic chart review in women at average risk of breast cancer, aged between 30 and 50, who underwent diagnostic mammograms and/or breast ultrasounds (US) at our institution between 2018 to 2019 for symptomatic clinical presentations (breast pain, palpable mass, nipple discharge or breast skin changes). Patients undergoing routine screening mammograms were excluded. We collected demographics, findings of initial and follow-up breast imaging (using the Breast Imaging Reporting and Data System (BI-RADS) &amp; breast density), and breast cancer diagnosis timelines where applicable. The primary outcome measure was the frequency of delayed breast cancer diagnosis defined as &amp;gt; 6 months from initial diagnostic imaging. Secondary outcomes included completion of recommended follow-up investigations and their outcomes, total number of breast cancer diagnoses and stage. The study was approved by the local research ethics board and the results were summarized using descriptive analysis. RESULTS We reviewed 400 electronic charts and identified 171 eligible patients. Mean age was 38 years; initial breast imaging included both diagnostic mammogram and US in 168 (87%), US alone in 20 (12%) and mammogram alone in 3 (2%) patients. Breast density was not routinely reported during this time frame. Ninety patients (53%) had benign findings (BIRADS 1 and 2), 41 (24%) had probable benign findings requiring short-term follow-up (BIRADS 3) while 30 (18%) patients had findings suspicious of malignancy (BIRADS 4&amp;5) with biopsy recommended for diagnosis. In the BIRADS 3 group, 93% had recommended follow-up at a median of 7.6 months. Breast US alone was the most common subsequent investigation of which 15 % were benign lesions (BIRADS 1 &amp; 2) and 68% remained in the BIRADS 3 category, while none were scored BIRADS 4 or 5. Among patients with BIRADS 4 &amp; 5 scores, 83% underwent recommended biopsy at a median time of 3 weeks. Ten (6%) out of all 171 patients were diagnosed with breast cancer, all of which had BIRADS 4 or 5 on initial diagnostic imaging. Stage distribution was as follows: stage 0 - 2 patients, stage 1- 7 patients and stage 2 - 1 patients with no locally advanced or metastatic disease. The mean time from initial imaging to breast cancer diagnosis was 1.5 weeks (range 1 to 22 weeks). None of the patients had delayed breast cancer diagnosis in our cohort. CONCLUSION More than half of patients with clinical breast findings in our cohort had benign findings on diagnostic mammogram and/or US (BIRADS 1&amp;2) with no subsequent breast diagnosis. Majority of patients requiring further investigations (BIRADS 0, 3, 4 and 5) underwent recommended follow-up (imaging or biopsy). Ultimately, a total of 10 patients were diagnosed with breast cancer at a median time of 1.5 weeks from original diagnostic imaging with no delayed breast cancer diagnosis. We, therefore, conclude that diagnostic mammograms and US are appropriate diagnostic investigations for clinical breast concerns in women between 30-50 years. Citation Format: Navdeep Dehar, Joseph N. Samuel, Doris Jabs, Wilma Hopman, Mihaela Mates. Outcomes of diagnostic breast imaging in young women (less than 50 years old) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-05-32.

Applications of different machine learning approaches in prediction of breast cancer diagnosis delay.

The increasing rate of breast cancer (BC) incidence and mortality in Iran has turned this disease into a challenge. A delay in diagnosis leads to more advanced stages of BC and a lower chance of survival, which makes this cancer even more fatal. The present study was aimed at identifying the predicting factors for delayed BC diagnosis in women in Iran. In this study, four machine learning methods, including extreme gradient boosting (XGBoost), random forest (RF), neural networks (NNs), and logistic regression (LR), were applied to analyze the data of 630 women with confirmed BC. Also, different statistical methods, including chi-square, p-value, sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC), were utilized in different steps of the survey. Thirty percent of patients had a delayed BC diagnosis. Of all the patients with delayed diagnoses, 88.5% were married, 72.1% had an urban residency, and 84.8% had health insurance. The top three important factors in the RF model were urban residency (12.04), breast disease history (11.58), and other comorbidities (10.72). In the XGBoost, urban residency (17.54), having other comorbidities (17.14), and age at first childbirth (>30) (13.13) were the top factors; in the LR model, having other comorbidities (49.41), older age at first childbirth (82.57), and being nulliparous (44.19) were the top factors. Finally, in the NN, it was found that being married (50.05), having a marriage age above 30 (18.03), and having other breast disease history (15.83) were the main predicting factors for a delayed BC diagnosis. Machine learning techniques suggest that women with an urban residency who got married or had their first child at an age older than 30 and those without children are at a higher risk of diagnosis delay. It is necessary to educate them about BC risk factors, symptoms, and self-breast examination to shorten the delay in diagnosis.

Disrupting the Status Quo in Late Diagnosis of Breast Cancers in the Resource Limited Settings

Breast cancer tops the list of female cancers both in incidence and mortality. Eastern and south Asian countries have seen a very significant 86%-89% rise in age standardized incidence. Currently 5-year survival of breast cancer in low- and middle-income countries is only 40-60%. There is an urgent need to reduce delays in diagnosis of breast cancer and establish effective referral pathways to improve the observed low survival. Existing literature describes reasons for such delays in breast cancer management extensively, yet does not propose solutions to disrupt this status quo. Pre-diagnostic delays and diagnostic delays are interdependent due to overlapping socioeconomic and cultural barriers to seeking health, and accessing and accepting care. Non-availability of diagnostic tests or trained human resource and out of pocket expenditure complicate these delays. Present article highlights probable solutions to mitigate these problems with an emphasis on resource limited settings. Early diagnosis of breast cancer essentially involves reducing the delays in triple assessment of symptomatic patients in the context of limited resources. Clinical breast examination, use of ultrasonography and fine needle aspiration biopsy which are possible to organize at secondary level can mitigate some of the delays. Newer technologies like portable ultrasound devices, use of artificial intelligence, cartridge based real time receptor assay can further reduce the diagnostic delay. Many pilot studies and interventions using newer point of care tests are in progress to establish their role against gold standard investigations in clinical practice. Delay in diagnosis cannot be mitigated by providing standalone solutions. Robust pathways with provision of green corridor for referrals, task shifting of patient navigation to various grassroot level health care workers, developing contextual practice guidelines, recognising challenges and weaknesses of cancer control system, and realizing importance of equitable distribution of health resources can strengthen the cancer control strategies and mitigate the delays in breast cancer diagnosis.

Are Diagnostic Delays Associated with Distress in Breast Cancer Patients?

Introduction: Receiving a new breast cancer diagnosis can cause anxiety and distress, which can lead to psychologic morbidity, decreased treatment adherence, and worse clinical outcomes. Understanding sources of distress is crucial in providing comprehensive care. This study aims to evaluate the relationship between delays in breast cancer diagnosis and patient-reported distress. Secondary outcomes include assessing patient characteristics associated with delay. Methods: Newly diagnosed breast cancer patients who completed a distress screening tool at their initial evaluation at an academic institution between 2014 and 2019 were retrospectively evaluated. The tool captured distress levels in the emotional, social, health, and practical domains with scores of “high distress” defined by current clinical practice guidelines. Delay from mammogram to biopsy, whether diagnostic or screening mammogram, was defined as >30 days. Result: 745 newly diagnosed breast cancer patients met inclusion criteria. Median time from abnormal mammogram to core biopsy was 12 days, and 11% of patients experienced a delay in diagnosis. The non-delayed group had higher emotional (p = 0.04) and health (p = 0.03) distress than the delayed group. No statistically significant differences in social distress were found between groups. Additionally, patients with higher practical distress had longer time interval between mammogram and surgical intervention compared to those with lower practical distress. Older age, diagnoses of invasive lobular carcinoma or ductal carcinoma in situ, and clinical anatomic stages 0-I were associated with diagnostic delay. Conclusion: Patients with higher emotional or health-related distress were more likely to have timely diagnoses of breast cancer, suggesting that patients with higher distress may seek healthcare interventions more promptly. Improved understanding of sources of distress will permit early intervention regarding the devastating impact of breast cancer diagnosis.

Diagnostic delay in breast cancer diagnosis: the role of health practitioners

Breast cancer is a significant health concern for women in Pakistan, with one in nine women facing a high lifetime risk of being diagnosed with the disease. Accessing timely and appropriate healthcare services for breast cancer patients can be challenging in Pakistan, and understanding the role of different health practitioners is essential to understand the functioning of the informal referral system. Therefore, this study aimed to explore the different aspects of patients' consultations with various health practitioners for diagnosing breast cancer symptoms. Data were collected from 168 breast cancer patients who had consulted local health practitioners before being diagnosed with breast cancer. Descriptive statistics, the Kruskal‒Wallis H test, and post hoc tests were used to analyze the data. The study found that most patients consulted general practitioners (59.52%) and pir (56.55%) for their health-related concerns. Consultants referred most patients to diagnostic centers, while pir and hakim referred no patients. Patients visited pir and general practitioners the most, but the average number of visits to pir and hakim was higher than that to other health practitioners (p &lt; 0.05). Moreover, pir (130 days) and hakim (120 days) had longer treatment periods than other health practitioners, with hakim charging the highest consultation fees [i.e., Pakistani rupees (PKR) 18,000] and patients incurring the highest travel expenses to visit pir (p &lt; 0.05). Our study highlights the challenges faced by breast cancer patients in seeking timely and effective healthcare services. The absence of a formal referral system resulted in prolonged diagnosis times, extensive travel, and financial burdens on the patients. The findings suggest the need to improve general public awareness regarding breast cancer symptoms and establish an active cancer referral system to achieve early diagnosis, timely treatment, and improved quality of life for breast cancer patients, especially those with a lower socioeconomic status.

Exploring causes of delays in help-seeking behaviours among symptomatic Omani women diagnosed with late-stage breast cancer - A qualitative study.

Breast cancer (BC) is the most commonly diagnosed cancer in Oman; however, the majority of women are diagnosed at a relatively young age and late stage. Delays in BC diagnosis may be attributable to patient-related barriers to medical help-seeking, such as embarrassment arising from breast examinations or negative perceptions of cancer or a cancer diagnosis. Identifying and addressing patients-related barriers to medical help-seeking may help early BC detection, increase the survival rate, and improve prognosis. This study aimed to explore causes of delays in medical help-seeking behaviours among symptomatic Omani women diagnosed with late-stage BC. Purposeful sampling was used to identify Omani women diagnosed with late-stage BC (i.e., stages III or IV) at the two main referral oncology centres in Oman. Semi-structured individual interviews were utilised to collect data regarding the participants' reasons for delaying seeking medical help. The qualitative framework analysis approach was used for data analysis. A total of 17 women participated in the study. The mean age was 41.94±7.87 years (range: 27-56 years). Six reasons for delays in seeking medical help were identified, including: (1) Being in denial of BC symptoms; (2) normalisation of BC symptoms attributed to hormonal changes, dietary changes, or work-induced stress; (3) misinterpretation of BC symptoms attributed to other diseases or expectation of more alarming/obvious BC symptoms; (4) pursuit of alternative medicine remedies; (5) false reassurance or incorrect advice from family members or friends; and (6) practical barriers, such as childcare responsibilities and lack of access to transport. Several reasons were identified for delays in seeking medical help for BC symptoms, including cultural and emotional factors and a lack of knowledge of BC symptoms. Increased awareness of BC symptoms and a better understanding of Omani women's beliefs, cultures, and behaviours may help to reduce delays in BC presentation and diagnosis.

The delay of breast cancer diagnosis and management during the Syrian war

BackgroundEarly detection of breast cancer (BC) is crucial for better prognosis especially in low-income countries, where advanced cancer stages are common. The Syrian war severely affected the healthcare system restraining the proper timely management of BC cases. We aimed to investigate the prevalence of patient- and system-related delays in BC diagnosis and management in Syria in addition to their predisposing characteristics and impact on the staging. MethodsThis is a cross-sectional retrospective cohort study on patients followed by the BC unit at Al-Bairouni main cancer center in Syria. The data were collected through personal interviews and retrospective revision of patients’ records. ResultsA total number of 519 patients were recruited; A quarter of them (n = 126) reported more than three months intervals between symptoms recognition and presentation to a physician. Additionally, 72 (13.9 %) patients received a confirmed diagnosis more than three months after presentation, and 12 (2.3 %) started treatment at least three months after the diagnosis. Patients who suffered from war-related inaccessibility to healthcare were 2.55 [1.58–4.11] times more likely to report significant delays. Additionally, the most common self-reported reasons for patient delay were the lack of awareness, which was more evident for less common symptoms like the change in breasts size, and shyness. Patients who reported significant delays were more likely to receive an advanced-stage diagnosis. ConclusionWar-related inaccessibility to healthcare rendered a significant group of BC patient susceptible to evident delay. This combined with significant system delays because of the overwhelmed hospitals, high costs, and insufficient personnel, equipment, medications, and training. However, personal factors, which might not be directly related to the war, like the inadequate awareness of rare symptoms and shyness still necessitate urgent interventions on the public knowledge and performed screening practices. These delays associated with receiving advanced-stage diagnoses and minimizing them can return better prognoses.

93 (PB-093) Poster - Causes and consequences of delayed diagnosis in breast cancer screening; focus on mammographic features and tumour characteristics

Background: Early detection of breast cancer is associated with more favourable outcomes, concerning tumour characteristics, risk of lymph node metastases and final surgical outcome. However, delay in breast cancer diagnosis is not uncommon. The current study aims to gain more insight in the prevalence, causes and consequences of delayed breast cancer diagnosis by analysing delayed screen-detected cancers as well as interval cancers.

Assessing the diagnosis Delay Among Breast Cancer Patients Attending in a Tertiary Care Hospital in Dhaka

Background: Diagnosis is a key determinant for any disease outcome. For that, we want to find out in which stage a breast cancer patient got admitted in hospital including various methods of laboratory investigations were done at different visits. Objectives: This study was aimed to generate information on the stages that a breast cancer patient got admitted including various methods of laboratory investigations were done at different visits. Methodology: We conducted a cross sectional study at the National Institute of Cancer Research and Hospital, Dhaka, Bangladesh from July 2017-June 2018. We randomly selected a total of 200 patients who came to that hospital through face-to-face interview by using pretested semi-structured questionnaire. Results: A total 77.0% (154) patients investigated Fine Needle Aspiration Cytology (FNAC) at first visit and mean duration for diagnosis was 11 months. Maximum patients came for diagnosis at stage II, III or IV; nobody came at stage I. As consequences, we found that stage of cancer had 7 times more likely to cause diagnostic delay (OR=7.957; 95% CI 3.206-19.749) p &lt;0.0001. Number of consultations was one of the cause for diagnostic delay (c2= 12.825, p &lt;0.0001). Diagnostic delay had strong association between first consultation with physician versus other health care providers (c2= 17.645, p &lt;0.0001). Excluding physicians, first consultation with health care providers also had 3 times more likely to cause delay in diagnosis (OR-3.862; 95% CI1.877-7.944) p&lt;0.0001. Conclusion: Breast cancer patients attended to health care provider at advanced stage. Knowledge, negative perception, social support were the contributing factor for delay in breast cancer diagnosis. Bangladesh Med Res Counc Bull 2021; 47(2): 136-142

Cost-effectiveness of using artificial intelligence versus polygenic risk score to guide breast cancer screening.

BackgroundCurrent guidelines for mammography screening for breast cancer vary across agencies, especially for women aged 40–49. Using artificial Intelligence (AI) to read mammography images has been shown to predict breast cancer risk with higher accuracy than alternative approaches including polygenic risk scores (PRS), raising the question whether AI-based screening is more cost-effective than screening based on PRS or existing guidelines. This study provides the first evidence to shed light on this important question.MethodsThis study is a model-based economic evaluation. We used a hybrid decision tree/microsimulation model to compare the cost-effectiveness of eight strategies of mammography screening for women aged 40–49 (screening beyond age 50 follows existing guidelines). Six of these strategies were defined by combinations of risk prediction approaches (AI, PRS or family history) and screening frequency for low-risk women (no screening or biennial screening). The other two strategies involved annual screening for all women and no screening, respectively. Data used to populate the model were sourced from the published literature.ResultsRisk prediction using AI followed by no screening for low-risk women is the most cost-effective strategy. It dominates (i.e., costs more and generates fewer quality adjusted life years (QALYs)) strategies for risk prediction using PRS followed by no screening or biennial screening for low-risk women, risk prediction using AI or family history followed by biennial screening for low-risk women, and annual screening for all women. It also extendedly dominates (i.e., achieves higher QALYs at a lower incremental cost per QALY) the strategy for risk prediction using family history followed by no screening for low-risk women. Meanwhile, it is cost-effective versus no screening, with an incremental cost-effectiveness ratio of $23,755 per QALY gained.ConclusionsRisk prediction using AI followed by no breast cancer screening for low-risk women is the most cost-effective strategy. This finding can be explained by AI’s ability to identify high-risk women more accurately than PRS and family history (which reduces the possibility of delayed breast cancer diagnosis) and fewer false-positive diagnoses from not screening low-risk women.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12885-022-09613-1.

Analysis of Factors Affecting Delayed Diagnosis of Women with Breast Cancer at Anugrah Medika Oncology Clinic in Kendari

The goal of this research is to determine the variables that contribute to breast cancer detection delays in women at Anugrah Medika Kendari Oncology Clinic. This is a cross sectional study using an analytic observational research approach. The data were examined univariately, bivariately, and multivariately using the multiple logistic regression approach. The findings indicated that, among the nine factors hypothesized to have an impact on breast cancer diagnosis delay, the variables (fear p=0.000; shyness p=0.001; alternative medicine p=0.000) were shown to have an influence on breast cancer diagnostic delay. Fear of exp (B1) = 24,621 &gt; 1 was a risk factor in multivariate analysis, and the 95 percent CI value was more than 1 (4,635 – 130,790), indicating that the OR was significant. The study's conclusion is that fear, shame, and alternative medicine were all found to be influential factors on the delay in diagnosis of breast cancer patients at the Anugrah Medika Kendari Oncology Clinic. Fear was found to be the most concurrently influential variable on the delay in diagnosis of breast cancer patients at the Anugrah Medika Kendari Oncology Clinic. Due to the importance of cooperation between clinics and psychologists supporting patients in overcoming psychological challenges, the government should prioritize upgrading facilities, access, and human resources, particularly in the area of cancer.

Barriers and Facilitators Influencing Arab Muslim Immigrant and Refugee Women's Breast Cancer Screening: A Narrative Review.

Introduction:This narrative review identifies barriers and facilitators influencing breast cancer screening among Arab Muslim immigrants and refugees. Low participation rates create health inequities in breast cancer screening among this population.Method:A systematic search of peer-reviewed empirical articles was performed. PRISMA, CASP, and MMAT checklists were used to appraise the studies.Results:Results include 3 themes: individual, health care system and health providers, and cultural factors.Discussion:Lack of fluency in the new country’s language, lack of knowledge, and poor exposure to breast cancer screening may contribute to the Arab Muslim women’s vulnerability to undiagnosed or delayed breast cancer diagnosis.

Understanding of Breast Cancer and SADARI Through Audio-Visual Health Education for Adolescents at Mutiara 2 High School Bandung

Lack of knowledge about breast cancer and never having a breast examination are factors that cause delays in breast cancer diagnosis. Proper education in health education is one of the primary keys to influencing knowledge. The implementation of this service activity aims to provide health education with audio-visual so that the insight and knowledge of adolescents will be better. Health education is carried out through WhatsApp group media which contains information about breast cancer and SADARI examination with the stages of making leaflets about breast cancer and SADARI, making videos about SADARI steps, measuring adolescent student knowledge by giving several questions in the form of a questionnaire about breast cancer and SADARI, evaluates health education for adolescent students by discussing and assessing the answers to the questionnaires that have been filled out by students. This service activity show an increase in the knowledge of young women before and after being given health education. The school can consider this activity to provide information support and motivation with various learning methods so that young women continuously get updated information in education and health knowledge. There is an increase in respondents’ knowledge after being given health education using audiovisual (60.0%) in the good category, which was previously only (13.3%) and the sufficient category (40.0%) and no less category.