Identifying Women at Risk of Delayed Breast Cancer Diagnosis
Authors: Stuver, Sherri O.; Zhu, Junya; Simchowitz, Brett; Hassett, Michael J.; Shulman, Lawrence N.; Weingart, Saul N.
Source: Joint Commission Journal on Quality and Patient Safety, Volume 37, Number 12, December 2011 , pp. 568
Publisher: Joint Commission Resources
Abstract:Background: Delays in breast cancer diagnosis contribute to increased morbidity and mortality. Factors related to the occurrence of delayed diagnosis have not been well studied.
Methods: A retrospective cohort study of 5,464 women newly diagnosed with breast cancer from 1999 through 2006 was conducted at a comprehensive cancer center in Boston. A delayed diagnosis was defined as an interval greater than 90 days between the patient's first breast-related problem that prompted seeking of medical care and the breast cancer diagnosis based on biopsy.
Results: 938 (17%) patients had a delayed breast cancer diagnosis. Non-white race or Hispanic ethnicity (adjusted odds ratio [OR] = 1.46, 95% confidence interval [CI] = 1.13–1.90), living more than 26 miles from Boston (OR 1.46, 95% CI = 1.25–1.71), and initial presentation with a lump found by the patient herself (OR = 2.89, 95% CI = 2.36–3.55) or another breast symptom (OR = 0.25, 95% CI = 1.79–2.82) compared to an abnormal mammogram were significantly associated with a delay in diagnosis. In contrast, the odds of a delay were lower for women who were older than 18–39 years of age and for women living with two or more household members (OR = 0.72, 95% CI = 0.59–0.87). The likelihood of experiencing a delayed breast cancer diagnosis increased markedly if a woman had multiple risk factors, with a nearly 12-fold increase among women with five or more risk factors (OR = 11.96, 95% CI = 6.32–22.61).
Conclusions: Younger age, minority race, and self-identification of breast symptom affect the likelihood of delayed breast cancer diagnosis. Awareness of these issues could help focus efforts to develop algorithms that identify women at risk for a delay and build programs that facilitate their timely access to care.
Document Type: Research Article
Publication date: December 1, 2011
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