title: Effect of longer health service provider delays on stage at diagnosis and mortality in symptomatic breast cancer.
abstract: OBJECTIVE
  This study explored whether longer provider delays (between first presentation and treatment) were associated with later stage and poorer survival in women with symptomatic breast cancer.
  
  
  METHODS
  Data from 850 women with symptomatic breast cancer were linked with the Scottish Cancer Registry; Death Registry; and hospital discharge dataset. Logistic regression and Cox survival analyses with restricted cubic splines explored relationships between provider delays, stage and survival, with sequential adjustment for patient and tumour factors.
  
  
  RESULTS
  Although confidence intervals were wide in both adjusted analyses, those with the shortest provider delays had more advanced breast cancer at diagnosis. Beyond approximately 20 weeks, the trend suggests longer delays are associated with more advanced stage, but is not statistically significant. Those with symptomatic breast cancer and the shortest presentation to treatment time (within 4 weeks) had the poorest survival. Longer time to treatment was not significantly associated with worsening mortality.
  
  
  CONCLUSIONS
  Poor prognosis patients with breast cancer are being triaged for rapid treatment with limited effect on outcome. Prolonged time to treatment does not appear to be strongly associated with poorer outcomes for patients with breast cancer, but the power of this study to assess the effect of very long delays (>25 weeks) was limited. Efforts to reduce waiting times are important from a quality of life perspective, but tumour biology may often be a more important determinant of stage at diagnosis and survival outcome.
authors.affiliation: Division of Applied Health Science, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK. Electronic address: p.murchie@abdn.ac.uk.
authors.forename: P
authors.initials: P
authors.lastname: Murchie
authors.affiliation: Division of Applied Health Science, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
authors.forename: E A
authors.initials: EA
authors.lastname: Raja
authors.affiliation: Division of Applied Health Science, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Lee
authors.affiliation: Scottish Cancer Registry, Information Services Division of NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9EB, UK.
authors.forename: D H
authors.initials: DH
authors.lastname: Brewster
authors.affiliation: Division of Applied Health Science, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
authors.forename: N C
authors.initials: NC
authors.lastname: Campbell
authors.affiliation: The Scottish Improvement Science Collaborating Centre (SISCC), University of Dundee, Ninewells Hospital & Medical School, Dundee DD1 9SY, UK.
authors.forename: N M
authors.initials: NM
authors.lastname: Gray
authors.affiliation: Division of Applied Health Science, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
authors.forename: L D
authors.initials: LD
authors.lastname: Ritchie
authors.affiliation: Scottish Collaboration for Public Health Research and Policy (SCPHRP), 20 West Richmond Street, Edinburgh EH8 9DX, UK.
authors.forename: R
authors.initials: R
authors.lastname: Robertson
authors.affiliation: Department of Oncology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN, UK.
authors.forename: L
authors.initials: L
authors.lastname: Samuel
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology; D057210:Delayed Diagnosis / Q000401:mortality*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009367:Neoplasm Staging / Q000401:mortality*; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D012606:Scotland
keywords: Breast cancer; Cancer staging; Delayed diagnosis; Diagnosis; Health services; Survival