title: Waiting time disparities in breast cancer diagnosis and treatment: a population-based study in France.
abstract: Waiting times are key indicators of a health's system performance, but are not routinely available in France. We studied waiting times for diagnosis and treatment according to patients' characteristics, tumours' characteristics and medical management options in a sample of 1494 breast cancers recorded in population-based registries. The median waiting time from the first imaging detection to the treatment initiation was 34 days. Older age, co-morbidity, smaller size of tumour, detection by organised screening, biopsy, increasing number of specimens removed, multidisciplinary consulting meetings and surgery as initial treatment were related to increased waiting times in multivariate models. Many of these factors were related to good practices guidelines. However, the strong influence of organised screening programme and the disparity of waiting times according to geographical areas were of concern. Better scheduling of diagnostic tests and treatment propositions should improve waiting times in the management of breast cancer in France.
authors.affiliation: Registre des cancers de Loire-Atlantique-Vendée, Nantes, France; Réseau Francim, Toulouse, France. Electronic address: fmolinie@chu-nantes.fr.
authors.forename: F
authors.initials: F
authors.lastname: Molinié
authors.forename: C
authors.initials: C
authors.lastname: Leux
authors.forename: P
authors.initials: P
authors.lastname: Delafosse
authors.forename: S
authors.initials: S
authors.lastname: Ayrault-Piault
authors.forename: P
authors.initials: P
authors.lastname: Arveux
authors.forename: A S
authors.initials: AS
authors.lastname: Woronoff
authors.forename: A V
authors.initials: AV
authors.lastname: Guizard
authors.forename: M
authors.initials: M
authors.lastname: Velten
authors.forename: O
authors.initials: O
authors.lastname: Ganry
authors.forename: S
authors.initials: S
authors.lastname: Bara
authors.forename: L
authors.initials: L
authors.lastname: Daubisse-Marliac
authors.forename: B
authors.initials: B
authors.lastname: Tretarre
mesh_terms: D000367:Age Factors; D000368:Aged; D001071:Appointments and Schedules; D001706:Biopsy; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D015897:Comorbidity; D019091:Critical Pathways / Q000706:statistics & numerical data; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D005260:Female; D005602:France; D005843:Geography / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010348:Patient Care Team / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data*
keywords: Breast neoplasm; Care access; Diagnostic work-up; Waiting times