title: Delay in diagnosis and treatment of symptomatic breast cancer in China.
abstract: BACKGROUND
  Delay in diagnosis and treatment of cancer may lead to advanced tumor characteristics and poor prognosis. Research and investigation from economically developing countries such as China are warranted to support these conclusions, so we studied the impact on prognosis of delays and factors predicting delay in symptomatic breast cancer patients in China.
  
  
  METHODS
  Medical records and follow-up information were collected. Variables including demographic data, and clinical and tumor characteristics, including patient age, menstrual status, residential status, initial symptom, profession, comorbidities, tumor size, lymph node metastasis, distant metastasis, history of breast disease, and family history of breast cancer, were analyzed, as was survival information.
  
  
  RESULTS
  A total of 1,431 women diagnosed with breast cancers between 1998 and 2005 in Qilu Hospital were enrolled and studied. Delays in diagnosis and treatment were correlated with larger tumor size, lymph node metastasis, late tumor stage, and worse disease-free survival, as assessed by multivariate logistic regression and Kaplan-Meier regression models. Patient residential status, initial symptom, menopausal status, and history of breast disease were independent predictors of delay. Stratified multivariate analyses confirmed that age was not associated with delay.
  
  
  CONCLUSIONS
  Delay in diagnosis and treatment predicts worse clinical outcomes. Improvement of medical service in rural areas, especially for premenopausal women, can decrease delays and benefit breast cancer patients.
authors.affiliation: Department of Breast Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China, hq329311270@163.com.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Huo
authors.forename: Chang
authors.initials: C
authors.lastname: Cai
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Kong
authors.forename: Liyu
authors.initials: L
authors.lastname: Jiang
authors.forename: Tingting
authors.initials: T
authors.lastname: Ma
authors.forename: Ning
authors.initials: N
authors.lastname: Zhang
authors.forename: Qifeng
authors.initials: Q
authors.lastname: Yang
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D002681:China; D015897:Comorbidity; D057210:Delayed Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors