title: An assessment of delays in obtaining definitive breast cancer treatment in Southern Italy.
abstract: Female population is medically underserved in Southern Italy (in comparison with other Italian regions). In a recent systematic review of published studies, delays of 3-6 months between symptom onset and treatment have been clearly associated with lower survival rates for breast cancer patients. The aim of this study was to examine breast cancer delays in medically underserved patients in Southern Italy, in order to recognize their determinating factors so as to provide women with a better opportunity for survival. The variables examined were age, education, symptom status at first presentation: symptomatic and asymptomatic, date of first symptom presentation, date of first consultation with a health provider, consulted provider, tumor size and nodal status, according to the pTNM system. Time intervals were categorized into: < 1 month, 1-3 months and > 3 months for patient and medical delay; 1-3 months, 3-6 months, > 6 months for overall delay. Patient delay was associated with education: a higher risk was found for women with < or = 5 years school attendance (OR = 3.3, 95%, CI 2.0-5.6). Medical delay was seen to be associated with the professional figure: significant differences were found between senologists (oncologist exclusively dedicated to breast cancer) and other specialists (OR 3.5, 95%, CI 1.5-8.4). Age and symptomatic presentation were found to be high risk factors. Concerning tumor size in overall delay in cases > 2 cm had OR values were of 2.4 (95%, CI 1.5-3.7). In conclusion our study suggests that diagnostic delay is associated with medically underserved status and can be reduced by educating younger and less educated women, as suggested in other studies and by providing training programs for members in the medical profession.
authors.affiliation: Department of Epidemiology, Fondazione G. Pascale, National Cancer Institute, Naples, Italy. legamont@tin.it
authors.forename: M
authors.initials: M
authors.lastname: Montella
authors.forename: A
authors.initials: A
authors.lastname: Crispo
authors.forename: G
authors.initials: G
authors.lastname: Botti
authors.forename: M
authors.initials: M
authors.lastname: De Marco
authors.forename: G
authors.initials: G
authors.lastname: de Bellis
authors.forename: G
authors.initials: G
authors.lastname: Fabbrocini
authors.forename: M
authors.initials: M
authors.lastname: Pizzorusso
authors.forename: M
authors.initials: M
authors.lastname: Tamburini
authors.forename: G
authors.initials: G
authors.lastname: D'Aiuto
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D003937:Diagnosis, Differential; D004493:Education; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007558:Italy; D008207:Lymphatic Metastasis; D008507:Medically Underserved Area; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012017:Referral and Consultation; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors