title: What influences diagnostic delay in low-income women with breast cancer?
abstract: BACKGROUND
  Delayed diagnosis of breast cancer (BC) may contribute to adverse outcomes, such as reduced survival. The purpose of this study was to identify correlates of elapsed time between recognition of breast abnormalities and receipt of definitive diagnosis of BC among low-income women.
  
  
  METHODS
  Data were obtained from a cross-sectional study among a statewide sample of 921 low-income women with a new diagnosis of BC. Patients were grouped by whether their breast abnormalities were self-detected or healthcare system detected. Multivariate logistic regression analyses were used to examine associations between diagnostic delay and patient characteristics, patient communication, and system characteristics.
  
  
  RESULTS
  The self-detected group experienced much greater delay than the system-detected group (median intervals 80.5 vs. 31.5 days). African Americans had the longest intervals between symptom detection and diagnostic resolution; median delays in the self-detected and system-detected subgroups were 115 and 70 days, respectively, compared to 64 and 22 days for Caucasians. In multivariate analyses, African Americans had considerably greater odds of >60-day delay than Caucasians in both the self-detected (odds ratio [OR] 3.51) and system-detected (OR 5.36) groups. Greater perceived self-efficacy in interacting with healthcare providers was significantly associated with shorter delay among the self-detected group (OR 0.86).
  
  
  CONCLUSIONS
  Disparities in timely BC diagnosis between African Americans and Caucasians were pronounced in this uniformly low-income population of women. Women with self-detected abnormalities had markedly greater delays than those with healthcare system-detected abnormalities. Among this vulnerable group, increasing self-efficacy in interacting with healthcare providers may reduce diagnostic delays.
authors.affiliation: Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024-4142, USA. rmaly@mednet.ucla.edu
authors.forename: Rose C
authors.initials: RC
authors.lastname: Maly
authors.forename: Barbara
authors.initials: B
authors.lastname: Leake
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Mojica
authors.forename: Yihang
authors.initials: Y
authors.lastname: Liu
authors.forename: Allison L
authors.initials: AL
authors.lastname: Diamant
authors.forename: Amardeep
authors.initials: A
authors.lastname: Thind
mesh_terms: D000328:Adult; D001294:Attitude to Health / Q000208:ethnology; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000208:ethnology; D016504:Breast Self-Examination / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000706:statistics & numerical data*; D010808:Physical Examination / Q000706:statistics & numerical data; D011203:Poverty / Q000706:statistics & numerical data*; D012044:Regression Analysis; D020377:Self Efficacy; D014481:United States / Q000453:epidemiology