title: Management delays for early gastric cancer in a country without mass screening.
abstract: OBJECTIVE
  To examine the symptoms of early gastric cancer and the time scale of management delays in a country without a mass screening program.
  
  
  METHODS
  Retrospective review of 44 patients with early gastric cancer.
  
  
  RESULTS
  Epigastric pain (63.3%) and gastrointestinal hemorrhage (27.3%) were the main symptoms found. Total delay was made up of patient delay (48.6%), doctor delay (25.5%) and treatment delay (25.9%). Median patient delay (from symptom onset to medical consult) was 30 days (inter-quartile range 2 to 365). Patient delay of more than 6 months was associated with patients aged 50 and younger (P = 0.04) and those presenting with pain (P = 0.05). Median doctor delay (consult to diagnosis) was 21 days (1 to 35) and median treatment delay (diagnosis to surgery) was 8 days (2 to 21). Doctor delay of more than 6 months was associated with a negative gastroscopy or barium meal in the previous 12 months (P = 0.03).
  
  
  CONCLUSIONS
  The detection of early gastric cancer at the symptomatic-detectable stage is possible and this potential window for diagnosis can be more than 1 year for up to one third of cases. Efforts to reduce management delays should be aimed at public education and improving the quality and accessibility of endoscopic evaluation.
authors.affiliation: Department of Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Republic of Singapore. melvin_look@ttsh.com.sg
authors.forename: M
authors.initials: M
authors.lastname: Look
authors.forename: Y Y
authors.initials: YY
authors.lastname: Tan
authors.forename: A
authors.initials: A
authors.lastname: Vijayan
authors.forename: C H
authors.initials: CH
authors.lastname: Teh
authors.forename: C H
authors.initials: CH
authors.lastname: Low
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001466:Barium Sulfate; D003287:Contrast Media; D005260:Female; D005773:Gastroscopy / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009367:Neoplasm Staging; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012846:Singapore; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D013997:Time Factors
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate