title: Clinical and prognostic factors associated with diagnostic wait times by breast cancer detection method.
abstract: BACKGROUND
  Although prognostic differences between screen-detected, interval and symptomatic breast cancers are known, factors associated with wait times to diagnosis among these three groups have not been studied.
  
  
  METHODS
  Of the 16,373 invasive breast cancers diagnosed between January 1, 1995 and December 31, 2003 in a cohort of Ontario women aged 50 to 69, a random sample (N = 2,615) were selected for chart abstraction. Eligible women were classified according to detection method; screen-detected (n = 1181), interval (n = 319) or symptomatic (n = 406). Diagnostic wait time was calculated from the initial imaging or biopsy to breast cancer diagnosis. Logistic regression analysis examined associations between diagnostic wait times dichotomized as greater or less than the median and demographic, clinical and prognostic factors separately for each detection cohort.
  
  
  RESULTS
  Women who underwent an open biopsy had significantly longer than median wait times to diagnosis, compared to women who underwent a fine needle aspiration or core biopsy; (screen-detected OR = 2.76, 95% CI = 2.14-3.56; interval OR = 2.56, 95% CI = 1.50-4.35; symptomatic OR = 5.56, 95% CI = 3.33-9.30). Additionally, screen-detected breast cancers diagnosed with stage II and symptomatic cancers diagnosed at stage III or IV had significantly shorter diagnostic wait times compared to those diagnosed at stage 1 (OR = 0.66 95% CI = 0.50-0.87 and OR = 0.46, 95% CI = 0.25-0.85 respectively).
  
  
  CONCLUSIONS
  Our study is consistent with expedited diagnostic work-up for breast cancers with more advanced prognostic features. Furthermore, women who had an open surgical biopsy had a greater than the median diagnostic wait time, irrespective of detection method.
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada ; Department of Laboratory Medicine and Pathobiology, University of Toronto and St. Michaels Hospital, Toronto, Canada.
authors.forename: Amalia
authors.initials: A
authors.lastname: Plotogea
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada ; Department of Laboratory Medicine and Pathobiology, University of Toronto and St. Michaels Hospital, Toronto, Canada.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Chiarelli
authors.affiliation: Department of Laboratory Medicine and Pathobiology, University of Toronto and St. Michaels Hospital, Toronto, Canada ; Women's College Hospital Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Lucia
authors.initials: L
authors.lastname: Mirea
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada.
authors.forename: Maegan V
authors.initials: MV
authors.lastname: Prummel
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada.
authors.forename: Nelson
authors.initials: N
authors.lastname: Chong
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada.
authors.forename: Rene S
authors.initials: RS
authors.lastname: Shumak
authors.affiliation: Department of Laboratory Medicine and Pathobiology, University of Toronto and St. Michaels Hospital, Toronto, Canada.
authors.forename: Frances P
authors.initials: FP
authors.lastname: O'Malley
authors.affiliation: Women's College Hospital Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Claire Mb
authors.initials: CM
authors.lastname: Holloway
keywords: Breast cancer; Diagnostic wait time; Interval cancers; Mammography; Screen-detected cancers; Symptomatic cancers
references.citation: Am J Public Health. 2000 Jan;90(1):130-4
references.pmid: 10630153
references.citation: Radiology. 1996 Jun;199(3):811-7
references.pmid: 8638010
references.citation: J Med Screen. 2004;11(3):130-4
references.pmid: 15333271
references.citation: Can J Public Health. 2005 Jul-Aug;96(4):259-63
references.pmid: 16625791
references.citation: Lancet. 1999 Apr 3;353(9159):1119-26
references.pmid: 10209974
references.citation: Can J Public Health. 2000 Mar-Apr;91(2):113-7
references.pmid: 10832174
references.citation: Eur J Cancer Prev. 2012 Nov;21(6):499-506
references.pmid: 22273849
references.citation: J Public Health Med. 1998 Dec;20(4):396-403
references.pmid: 9923945
references.citation: Cancer. 2010 Sep 1;116(17):4160-7
references.pmid: 20681012
references.citation: Can J Surg. 2005 Jun;48(3):185-94
references.pmid: 16013621
references.citation: Br J Cancer. 1998 Apr;77(8):1343-8
references.pmid: 9579844
references.citation: Cancer. 2002 Apr 15;94(8):2143-50
references.pmid: 12001110
references.citation: J Med Screen. 2004;11(1):28-31
references.pmid: 15006111
references.citation: J Epidemiol Community Health. 1995 Aug;49(4):413-8
references.pmid: 7650466
references.citation: Lancet. 1999 Apr 3;353(9159):1127-31
references.pmid: 10209975
references.citation: Br J Cancer. 2007 Mar 12;96(5):836-40
references.pmid: 17311024
references.citation: J Surg Oncol. 1996 Nov;63(3):141-4
references.pmid: 8944056
references.citation: Eur J Cancer Prev. 2006 Feb;15(1):34-42
references.pmid: 16374227
references.citation: Ann Surg Oncol. 2007 Oct;14(10):2932-9
references.pmid: 17619931
references.citation: J Natl Compr Canc Netw. 2009 Nov;7(10):1060-96
references.pmid: 19930975
references.citation: Eur J Surg Oncol. 2008 Feb;34(2):149-53
references.pmid: 17498912
references.citation: J Natl Cancer Inst Monogr. 1997;(22):131-8
references.pmid: 9709289
references.citation: J Oncol Pract. 2012 Mar;8(2):107-12
references.pmid: 23077438
references.citation: CMAJ. 2001 Aug 7;165(3):277-83
references.pmid: 11517642
references.citation: Arch Intern Med. 2006 Nov 13;166(20):2244-52
references.pmid: 17101943
references.citation: Cancer Detect Prev. 2004;28(5):361-7
references.pmid: 15542262