title: Delay in presentation of symptomatic referrals to a breast clinic: patient and system factors.
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.
authors.affiliation: Department of Psychological Medicine, King's College School of Medicine and Institute of Psychiatry, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Nosarti
authors.forename: T
authors.initials: T
authors.lastname: Crayford
authors.forename: J V
authors.initials: JV
authors.lastname: Roberts
authors.forename: E
authors.initials: E
authors.lastname: Elias
authors.forename: K
authors.initials: K
authors.lastname: McKenzie
authors.forename: A S
authors.initials: AS
authors.lastname: David
mesh_terms: D000328:Adult; D000368:Aged; D001941:Breast Diseases / Q000175:diagnosis / Q000503:physiopathology*; D001943:Breast Neoplasms / Q000175:diagnosis / Q000503:physiopathology*; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D013997:Time Factors