Causes of physician delay in the diagnosis of breast cancer.
BACKGROUND
Understanding sources of physician delay in diagnosis of breast cancer will assist efforts to expedite diagnosis.


OBJECTIVE
To test whether increased reliance on screening mammography has affected causes of physician delay in diagnosis of breast cancer.


METHODS
Survey of delays in a case series.


METHODS
Practice specializing in breast diseases in a region with high use of screening mammography.


METHODS
Four hundred thirty-five consecutive patients treated for 454 breast cancers of any stage.


METHODS
Customary patient care.


METHODS
Whether delay was related to how cancer was identified, patient age, individual cancer characteristics (such as tumor type), mammography reports, or physician expertise.


RESULTS
Twenty-one women (5%) were inappropriately reassured that a malignant lump was benign without biopsy, 14 women (3%) had a misread mammogram, 4 women (1%) had a misread pathologic finding, and 5 women (1%) had cancer missed by a poorly performed fine-needle aspiration biopsy. Delay was associated with a benign mammography report (relative risk, 10.8; 95% confidence interval, 5.1-22.8), a woman finding her own mass (relative risk, 3.3; 95% confidence interval, 1.8-6.2), and current hormone replacement therapy (relative risk, 3.1; 95% confidence interval, 1.2-8.5).


CONCLUSIONS
The leading cause of physician delay in diagnosis of breast cancer continues to be inappropriate reassurance that a mass is benign without biopsy. Reducing delay in diagnosis will require less willingness to rely on clinical examination to decide that a mass is benign, less reliance on benign mammography reports to decide not to biopsy a mass, and a requirement that fine-needle aspiration biopsy be done by persons with demonstrated competence for the procedure.
Goodson
William H
WH
Department of Surgery, California Pacific Medical Research Institute, 2100 Webster, Suite 401, San Francisco, CA 94115, USA. whg3@cooper.cpmc.org
Moore
Dan H
DH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D002140:California / Q000453:epidemiology; D002983:Clinical Competence; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D010819:Physician's Role; D010818:Practice Patterns, Physicians'; D011787:Quality of Health Care; D012306:Risk; D016387:Women's Health