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. 2000 Jan 18;82(3):742–748. doi: 10.1054/bjoc.1999.0990

Delay in presentation of symptomatic referrals to a breast clinic: patient and system factors

C Nosarti 1, T Crayford 2, J V Roberts 3, E Elias 3, K McKenzie 1, A S David 1
PMCID: PMC2363314  PMID: 10682692

Abstract

We attempted to identify factors associated with delay in presentation and assessment of women with breast symptoms who attended a London breast clinic. A total of 692 consecutive symptomatic referrals, aged 40–75 years, were studied. Patient delay, assessed prior to diagnosis, was defined as time elapsing between symptom discovery and first presentation to a medical provider. This was studied in relation to: reasons for delaying, beliefs and attitudes, socio-demographic and clinical variables, psychiatric morbidity and subsequent diagnosis. Thirty-five per cent of the cohort delayed presentation 4 weeks or more (median 13 days). The most common reason given was that they thought their symptom was not serious (odds ratio (OR) = 5.32, 95% confidence interval (CI) 3.6–8.0). Others thought their symptom would go away (OR = 3.73, 95% CI 2.2–6.4) or delayed because they were scared (OR = 4.61, 95% CI 2.1–10.0). Delay was associated with psychiatric morbidity but not age. Patients who turned out to have cancer tended to delay less (median 7 days) but not significantly. Median system delay – time between first medical consultation and first clinic visit – was 18 days. Patients who thought they had cancer and those so diagnosed were seen more promptly (median 14 days). Most factors, including socio-economic status and ethnicity were non-contributory. Beliefs about breast symptoms and their attribution are the most important factors determining when women present. Health education messages should aim to convince symptomatic women that their condition requires urgent evaluation, without engendering fear in them. © 2000 Cancer Research Campaign

Keywords: patient delay, system delay, breast symptoms, breast cancer, reasons for delaying

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Selected References

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  1. Adam S. A., Horner J. K., Vessey M. P. Delay in treatment for breast cancer. Community Med. 1980 Aug;2(3):195–201. doi: 10.1007/BF02549023. [DOI] [PubMed] [Google Scholar]
  2. Burgess C. C., Ramirez A. J., Richards M. A., Love S. B. Who and what influences delayed presentation in breast cancer? Br J Cancer. 1998 Apr;77(8):1343–1348. doi: 10.1038/bjc.1998.224. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Caplan L. S. Patient delay in seeking help for potential breast cancer. Public Health Rev. 1995;23(3):263–274. [PubMed] [Google Scholar]
  4. Darrow S. L., Schoenfeld E. R., Cummings K. M., Wilkes E., Madoff S. Women's knowledge and beliefs about breast cancer risk factors, symptoms, detection methods, and treatments. J Cancer Educ. 1987;2(3):165–176. doi: 10.1080/08858198709527878. [DOI] [PubMed] [Google Scholar]
  5. Douglas C. J., Druss R. G. Denial of illness: a reappraisal. Gen Hosp Psychiatry. 1987 Jan;9(1):53–57. doi: 10.1016/0163-8343(87)90102-2. [DOI] [PubMed] [Google Scholar]
  6. Eley J. W., Hill H. A., Chen V. W., Austin D. F., Wesley M. N., Muss H. B., Greenberg R. S., Coates R. J., Correa P., Redmond C. K. Racial differences in survival from breast cancer. Results of the National Cancer Institute Black/White Cancer Survival Study. JAMA. 1994 Sep 28;272(12):947–954. doi: 10.1001/jama.272.12.947. [DOI] [PubMed] [Google Scholar]
  7. Elwood J. M., Moorehead W. P. Delay in diagnosis and long-term survival in breast cancer. Br Med J. 1980 May 31;280(6227):1291–1294. doi: 10.1136/bmj.280.6227.1291. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Facione N. C. Delay versus help seeking for breast cancer symptoms: a critical review of the literature on patient and provider delay. Soc Sci Med. 1993 Jun;36(12):1521–1534. doi: 10.1016/0277-9536(93)90340-a. [DOI] [PubMed] [Google Scholar]
  9. Gould-Martin K., Paganini-Hill A., Casagrande C., Mack T., Ross R. K. Behavioral and biological determinants of surgical stage of breast cancer. Prev Med. 1982 Jul;11(4):429–440. doi: 10.1016/0091-7435(82)90046-9. [DOI] [PubMed] [Google Scholar]
  10. Greer S. Psychological aspects: delay in the treatment of breast cancer. Proc R Soc Med. 1974 Jun;67(6 Pt 1):470–473. doi: 10.1177/00359157740676P121. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Gregorio D. I., Cummings K. M., Michalek A. Delay, stage of disease, and survival among White and Black women with breast cancer. Am J Public Health. 1983 May;73(5):590–593. doi: 10.2105/ajph.73.5.590. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Hackett T. P., Cassem N. H., Raker J. W. Patient delay in cancer. N Engl J Med. 1973 Jul 5;289(1):14–20. doi: 10.1056/NEJM197307052890104. [DOI] [PubMed] [Google Scholar]
  13. Haigney E., Morgan R., King D., Spencer B. Breast examinations in older women: questionnaire survey of attitudes of patients and doctors. BMJ. 1997 Oct 25;315(7115):1058–1059. doi: 10.1136/bmj.315.7115.1058. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Huguley C. M., Jr, Brown R. L. The value of breast self-examination. Cancer. 1981 Mar 1;47(5):989–995. doi: 10.1002/1097-0142(19810301)47:5<989::aid-cncr2820470530>3.0.co;2-v. [DOI] [PubMed] [Google Scholar]
  15. Hunter C. P., Redmond C. K., Chen V. W., Austin D. F., Greenberg R. S., Correa P., Muss H. B., Forman M. R., Wesley M. N., Blacklow R. S. Breast cancer: factors associated with stage at diagnosis in black and white women. Black/White Cancer Survival Study Group. J Natl Cancer Inst. 1993 Jul 21;85(14):1129–1137. doi: 10.1093/jnci/85.14.1129. [DOI] [PubMed] [Google Scholar]
  16. MacArthur C., Smith A. Delay in breast cancer and the nature of presenting symptoms. Lancet. 1981 Mar 14;1(8220 Pt 1):601–603. doi: 10.1016/s0140-6736(81)92044-4. [DOI] [PubMed] [Google Scholar]
  17. Nichols S. Reluctance to seek medical advice about breast symptoms. J R Coll Gen Pract. 1983 Mar;33(248):163–166. [PMC free article] [PubMed] [Google Scholar]
  18. Phelan M., Dobbs J., David A. S. 'I thought it would go away': patient denial in breast cancer. J R Soc Med. 1992 Apr;85(4):206–207. doi: 10.1177/014107689208500409. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Ramirez A. J., Westcombe A. M., Burgess C. C., Sutton S., Littlejohns P., Richards M. A. Factors predicting delayed presentation of symptomatic breast cancer: a systematic review. Lancet. 1999 Apr 3;353(9159):1127–1131. doi: 10.1016/s0140-6736(99)02142-x. [DOI] [PubMed] [Google Scholar]
  20. Richards M. A., Westcombe A. M., Love S. B., Littlejohns P., Ramirez A. J. Influence of delay on survival in patients with breast cancer: a systematic review. Lancet. 1999 Apr 3;353(9159):1119–1126. doi: 10.1016/s0140-6736(99)02143-1. [DOI] [PubMed] [Google Scholar]
  21. Richardson J. L., Langholz B., Bernstein L., Burciaga C., Danley K., Ross R. K. Stage and delay in breast cancer diagnosis by race, socioeconomic status, age and year. Br J Cancer. 1992 Jun;65(6):922–926. doi: 10.1038/bjc.1992.193. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Timko C. Seeking medical care for a breast cancer symptom: determinants of intentions to engage in prompt or delay behavior. Health Psychol. 1987;6(4):305–328. doi: 10.1037//0278-6133.6.4.305. [DOI] [PubMed] [Google Scholar]
  23. Williams E. M., Baum M., Hughes L. E. Delay in presentation of women with breast disease. Clin Oncol. 1976 Dec;2(4):327–331. [PubMed] [Google Scholar]
  24. Zervas I. M., Augustine A., Fricchione G. L. Patient delay in cancer. A view from the crisis model. Gen Hosp Psychiatry. 1993 Jan;15(1):9–13. doi: 10.1016/0163-8343(93)90085-3. [DOI] [PubMed] [Google Scholar]

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