Understanding why women delay in seeking help for breast cancer symptoms.
OBJECTIVE
The aim of this study was to improve our understanding of why women delay their presentation with breast cancer.


METHODS
A review of the evidence for the adverse effect of delayed presentation on survival and the risk factors for delay was conducted. The description and rationale for a model to explain the delay process are presented.


RESULTS
Delays of 3 months or more adversely affect survival. Older age, the nature of the breast symptom, not disclosing the symptom to someone close, negative attitudes towards general practitioner (GP) and fears about cancer treatment are risk factors for delay. Using elements of self-regulation theory, the theory of planned behaviour (TPB) and implementation intentions, a theoretical model is proposed to explain delayed help-seeking. The model incorporates stages of symptom appraisal, attitudes towards help-seeking and translating intentions into behaviour.


CONCLUSIONS
Placing the empirical risk factors for delayed presentation in a theoretically derived model should enable the development of an effective intervention to reduce delay and thereby save lives.
Bish
Alison
A
Cancer Research UK London Psychosocial Group, Adamson Centre for Mental Health, Saint Thomas's Hospital, London SE1 7EH, UK. alison.bish@kcl.ac.uk
Ramirez
Amanda
A
Burgess
Caroline
C
Hunter
Myra
M
D001364:Awareness; D001943:Breast Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000523:psychology*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008960:Models, Psychological; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D012017:Referral and Consultation; D012803:Sick Role; D016019:Survival Analysis