title: Who and what influences delayed presentation in breast cancer?
abstract: This study aimed to examine the extent and determinants of patient and general practitioner delay in the presentation of breast cancer. One hundred and eighty-five cancer patients attending a breast unit were interviewed 2 months after diagnosis. The main outcome measures were patient delay in presentation to the general practitioner and non-referral by the general practitioner to hospital after the patient's first visit. Nineteen per cent of patients delayed > or = 12 weeks. Patient delay was related to clinical tumour size > or = 4 cm (P = 0.0002) and with a higher incidence of locally advanced and metastatic disease (P = 0.01). A number of factors predicted patient delay: initial breast symptom(s) that did not include a lump (OR 4.5, P = 0.003), not disclosing discovery of the breast symptom immediately to someone else (OR 6.0, P < 0.001), seeking help only after being prompted by others (OR 4.4, P = 0.007) and presenting to the general practitioner with a non-breast problem (OR 3.5, P = 0.03). Eighty-three per cent of patients were referred to hospital directly after their first general practitioner visit. Presenting to the GP with a breast symptom that did not include a lump independently predicted general practitioner delay (OR 3.6, P = 0.002). In view of the increasing evidence that delay adversely affects survival, a large multicentre study is now warranted to confirm these findings that may have implications for public and medical education.
authors.affiliation: ICRF Psychosocial Oncology Group, United Medical School of Guy's Hospital, London, UK.
authors.forename: C C
authors.initials: CC
authors.lastname: Burgess
authors.forename: A J
authors.initials: AJ
authors.lastname: Ramirez
authors.forename: M A
authors.initials: MA
authors.lastname: Richards
authors.forename: S B
authors.initials: SB
authors.lastname: Love
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000523:psychology* / Q000628:therapy; D015331:Cohort Studies; D005194:Family Practice; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors