title: Delay in diagnosis of retinoblastoma: risk factors and treatment outcome.
abstract: BACKGROUND
  Delay in diagnosis of retinoblastoma causes considerable parental distress; however, the primary healthcare professional (PHP) may have difficulty detecting the most common presenting symptom-leucocoria. Alternatively, the PHP may not appreciate that retinoblastoma is the pathology underlying more common ocular symptoms in infants and young children.
  
  
  METHODS
  The parents of 100 recently diagnosed patients with retinoblastoma were interviewed to establish the extent of diagnostic delay, ascertain any associated risk factors, and to determine whether or not delay influenced treatment outcome.
  
  
  RESULTS
  Although nearly 50% of patients were referred to an ophthalmologist within 1 week of first consulting a PHP, one quarter waited more than 8 weeks. There was a significantly increased risk of diagnostic delay in younger patients, those presenting with squint rather than leucocoria, and those first presenting to a health visitor rather than to a general practitioner. The risk of local tumour invasion was significantly increased by diagnostic delay. Treatment with primary enucleation was not increased by diagnostic delay. There were no deaths during the study period.
  
  
  CONCLUSIONS
  Primary healthcare professionals require education about the importance of ocular symptoms, especially squint, in paediatric patients.
authors.affiliation: Department of Paediatric Oncology, St Bartholomew's Hospital, London.
authors.forename: A G
authors.initials: AG
authors.lastname: Goddard
authors.forename: J E
authors.initials: JE
authors.lastname: Kingston
authors.forename: J L
authors.initials: JL
authors.lastname: Hungerford
mesh_terms: D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011320:Primary Health Care / Q000592:standards; D012017:Referral and Consultation / Q000592:standards; D019572:Retinal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D012175:Retinoblastoma / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome