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Identifying Women at Risk of Delayed Breast Cancer Diagnosis

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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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  • Published monthly, The Joint Commission Journal on Quality and Patient Safety is a peer-reviewed publication dedicated to providing health professionals with the information they need to promote the quality and safety of health care. The Joint Commission Journal on Quality and Patient Safety invites original manuscripts on the development, adaptation, and/or implementation of innovative thinking, strategies, and practices in improving quality and safety in health care. Case studies, program or project reports, reports of new methodologies or new applications of methodologies, research studies on the effectiveness of improvement interventions, and commentaries on issues and practices are all considered.

    Also known as Joint Commission Journal on Quality Improvement and Joint Commission Journal on Quality and Safety
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