title: Health care strategies to promote earlier presentation of symptomatic breast cancer: perspectives of women and family physicians.
abstract: BACKGROUND
  Many women with symptoms suggestive of a breast cancer diagnosis delay presentation to their family physician. Although factors associated with delay have been well described, there is a paucity of data on strategies to mitigate delay.
  
  
  OBJECTIVE
  We conducted a qualitative research project to examine factors related to delay and to identify health care system changes that might encourage earlier presentation.
  
  
  METHODS
  Individual semi-structured interviews were conducted with women who sought care 12 weeks or more after self-detection of breast cancer symptoms and with family physicians whose practices included patients meeting that criterion.
  
  
  RESULTS
  The women and physicians both suggested a need for clearer screening mammography guidelines for women 40-49 years of age and for better messaging concerning breast awareness. The use of additional hopeful testimonials from breast cancer survivors were suggested to help dispel the notion of cancer as a "death sentence." Educational initiatives were proposed, aimed at both increasing awareness of "non-lump" breast cancer symptoms and advising women that a previous benign diagnosis does not ensure that future symptoms are not cancer. Women wanted empathic nonjudgmental access to care. Improved methods to track compliance with screening mammography and with periodic health exams and access to a rapid diagnostic process were suggested.
  
  
  CONCLUSIONS
  A list of "at-risk situations for delay" in diagnosis of breast cancer was developed for physicians to assist in identifying women who might delay. Health care system changes actionable both at the health policy level and in the family physician's office were identified to encourage earlier presentation of women with symptomatic breast cancer.
authors: Department of Family and Community Medicine, Women's College Hospital, University of Toronto, Toronto, ON.
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authors: Heisey
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authors: Clemons
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authors: Granek
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authors: Fergus
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authors: Hum
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authors: McCready
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authors: Fitzgerald