title: Determinants of delay for breast cancer diagnosis.
abstract: BACKGROUND
  A study was conducted to identify determinants of diagnostic delay in order to develop strategies to reduce the waiting time for breast cancer diagnosis.
  
  
  METHODS
  A cohort of 696 women diagnosed with early breast cancer was recruited in two radiation oncology centers of Quebec, Canada, in 2002-2003. A structured questionnaire was administered to identify potential determinants of diagnostic delay. Dates for all of the breast procedures were extracted from medical records. "Diagnostic delay" was defined as a time interval of more than 5 weeks between the first breast specific procedure and the final diagnostic procedure. A logistic regression model was used to estimate adjusted odds ratios (OR) of diagnostic delay and their 95% confidence intervals (CI).
  
  
  RESULTS
  The two main determinants of diagnostic delay were the medical indication for the breast investigation and the scheduling of the diagnostic procedures. Compared to screened women, those referred because of clinical findings had an OR of diagnostic delay of 0.34 (95% CI=0.22-0.54). Women who underwent breast procedures during visits on at least four separate days had an OR of 6.31 (95% CI=3.85-10.34) compared to those who completed their investigation during visits on at most two separate days. Women who had complementary procedures the day of the first procedure were less likely to experience a diagnostic delay (OR=0.51, 95% CI=0.31-0.82). Finally, diagnostic delay was also significantly associated with the interpretation of the first diagnostic procedure, type of final diagnostic procedure, size of tumor, and family income.
  
  
  CONCLUSIONS
  This study suggests that a promising strategy for reducing the waiting time for breast cancer diagnosis is to better integrate the services during the investigation period.
authors.affiliation: Laval University Cancer Research Center, Canada. isabelle.bairati@chuq.qc.ca
authors.forename: Isabelle
authors.initials: I
authors.lastname: Bairati
authors.forename: Edith
authors.initials: E
authors.lastname: Jobin
authors.forename: Lise
authors.initials: L
authors.lastname: Fillion
authors.forename: Marie
authors.initials: M
authors.lastname: Larochelle
authors.forename: Linda
authors.initials: L
authors.lastname: Vincent
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D015331:Cohort Studies; D003266:Continuity of Patient Care; D019033:Delivery of Health Care, Integrated; D005260:Female; D006801:Humans; D008875:Middle Aged; D011792:Quebec; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D013997:Time Factors