title: Trends in time to diagnosis of colon cancer and impact on clinical outcomes.
abstract: BACKGROUND
  There has been a rapid increase in screening for colorectal cancer (CRC) over the past several years in North America. This could paradoxically lead to worsening outcomes if the system is not adapted to deal with the increased demand. For example, this could create increased wait times for endoscopy and delayed time to CRC diagnosis, which could worsen clinical outcomes such as stage at diagnosis and⁄or survival. No previous Canadian study has evaluated the association between time to CRC diagnosis and clinical outcomes.
  
  
  METHODS
  The present historical cohort study used Manitoba's population-based cancer registry and Manitoba Health administrative databases. The effect of time to diagnosis on patient survival was evaluated using Cox regression analysis with adjustment for stage at diagnosis, grade of CRC, age, sex, socioeconomic status, comorbidity index score and year of CRC diagnosis. The association between time to diagnosis and CRC stage at diagnosis was evaluated using multivariate logistic regression analysis.
  
  
  RESULTS
  The median time to CRC diagnosis increased significantly from 72 days (95% CI 61 days to 83 days) in 2004 to 105 days (95% CI 64 days to 129 days) in the first three months of 2009 (P=0.04). There was no significant association between time to diagnosis and survival. Individuals with the longest time to diagnosis were less likely to have stage III⁄IV CRC at diagnosis (quartile 4 versus quartile 1: OR 0.50 [95% CI 0.33 to 0.75).
  
  
  CONCLUSIONS
  Time to CRC diagnosis is continuing to increase in Manitoba. Although the present study did not detect a significant negative clinical effect of increasing time to diagnosis, additional studies are required.
authors.affiliation: Department of Epidemiology and Cancer Registry, Winnipeg, Manitoba.
authors.forename: Harminder
authors.initials: H
authors.lastname: Singh
authors.forename: Emma
authors.initials: E
authors.lastname: Shu
authors.forename: Alain
authors.initials: A
authors.lastname: Demers
authors.forename: Charles N
authors.initials: CN
authors.lastname: Bernstein
authors.forename: Jane
authors.initials: J
authors.lastname: Griffith
authors.forename: Katherine
authors.initials: K
authors.lastname: Fradette
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis*; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000401:mortality; D015179:Colorectal Neoplasms / Q000175:diagnosis; D057210:Delayed Diagnosis / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008350:Manitoba; D008875:Middle Aged; D017063:Outcome Assessment, Health Care