title: Delays in diagnosis and treatment of breast cancer: a multinational analysis.
abstract: BACKGROUND
  Reducing treatment delay improves outcomes in breast cancer. The aim of this study was to determine factors influencing patient- and system-related delays in commencing breast cancer treatment in different countries.
  
  
  METHODS
  A total of 6588 female breast cancer patients from 12 countries were surveyed. Total delay time was determined as the sum of the patient-related delay time (time between onset of the first symptoms and the first medical visit) and system-related delay time (time between the first medical visit and the start of therapy).
  
  
  RESULTS
  The average patient-related delay time and total delay time were 4.7 (range: 3.4-6.2) weeks and 14.4 (range: 11.5-29.4) weeks, respectively. Longer patient-related delay times were associated with distrust and disregard, and shorter patient-related delay times were associated with fear of breast cancer, practicing self-examination, higher education level, being employed, having support from friends and family and living in big cities. The average system-related delay time was 11.1 (range: 8.3-24.7) weeks. Cancer diagnosis made by an oncologist versus another physician, higher education level, older age, family history of female cancers and having a breast lump as the first cancer sign were associated with shorter system-related delay times. Longer patient-related delay times and higher levels of distrust and disregard were predictors of longer system-related delay times.
  
  
  CONCLUSIONS
  The delay in diagnosis and treatment of breast cancer remains a serious problem. Several psychological and behavioural patient attributes strongly determine both patient-related delay time and system-related delay time, but their strength is different in particular countries.
authors.affiliation: 1 Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland jjassem@gumed.edu.pl.
authors.forename: Jacek
authors.initials: J
authors.lastname: Jassem
authors.affiliation: 2 Department of Surgery, Istanbul University, Istanbul, Turkey.
authors.forename: Vahit
authors.initials: V
authors.lastname: Ozmen
authors.affiliation: 3 Departament of Clinical Oncology, Sf Maria Hospital, Bucharest, Romania.
authors.forename: Florin
authors.initials: F
authors.lastname: Bacanu
authors.affiliation: 4 Radiotherapy and Drug Therapy Center, Institute of Oncology, Vilnius University, Vilnius, Lithuania.
authors.forename: Monika
authors.initials: M
authors.lastname: Drobniene
authors.affiliation: 5 Department of Breast Surgery, Oncology Centre of Latvia, Riga East University Hospital, Riga, Latvia.
authors.forename: Janis
authors.initials: J
authors.lastname: Eglitis
authors.affiliation: 6 Department of Medical Oncology, Kidwai Memorial Institute of Oncology, India.
authors.forename: Kuntegowdanahalli C
authors.initials: KC
authors.lastname: Lakshmaiah
authors.affiliation: 7 Department of Oncotherapy, University of Szeged, Szeged, Hungary.
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Kahan
authors.affiliation: 8 2nd Department of Oncology, National Cancer Institute and Medical School of Comenius University, Bratislava, Slovak Republic.
authors.forename: Jozef
authors.initials: J
authors.lastname: Mardiak
authors.affiliation: 9 Department of Oncology and Surgery, Medical Centre of Postgraduate Education, Otwock, Poland.
authors.forename: Tadeusz
authors.initials: T
authors.lastname: Pieńkowski
authors.affiliation: 10 Department of Medical Oncology, Petrov Research Institute of Oncology, St. Petersburg, Russia.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Semiglazova
authors.affiliation: 11 Department of Medical Oncology, Institute of Oncology and Radiology, Belgrade, Serbia.
authors.forename: Ljiljana
authors.initials: L
authors.lastname: Stamatovic
authors.affiliation: 12 Department of Chemotherapy, Specialized Hospital for Active Treatment in Oncology, Sofia, Bulgaria.
authors.forename: Constanta
authors.initials: C
authors.lastname: Timcheva
authors.affiliation: 11 Department of Medical Oncology, Institute of Oncology and Radiology, Belgrade, Serbia.
authors.forename: Suzana
authors.initials: S
authors.lastname: Vasovic
authors.affiliation: 13 Department of Medical Oncology, Clinic of Oncology, Zagreb University Hospital Centre, Zagreb, Croatia.
authors.forename: Damir
authors.initials: D
authors.lastname: Vrbanec
authors.affiliation: 14 Collegium of World Economy, Warsaw School of Economics, Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Zaborek
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001208:Asia; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000523:psychology*; D005060:Europe; D005239:Fear / Q000523:psychology; D005260:Female; D015438:Health Behavior; D006801:Humans; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data*; D016353:Self-Examination / Q000523:psychology / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D035502:Trust / Q000523:psychology