title: Health system delay and its effect on clinical stage of breast cancer: Multicenter study.
abstract: BACKGROUND
  The objective of this study was to determine the correlation between health system delay and clinical disease stage in patients with breast cancer.
  
  
  METHODS
  This was a cross-sectional study of 886 patients who were referred to 4 of the largest public cancer hospitals in Mexico City for the evaluation of a probable breast cancer. Data on time intervals, sociodemographic factors, and clinical stage at diagnosis were retrieved. A logistic regression model was used to estimate the average marginal effects of delay on the probability of being diagnosed with advanced breast cancer (stages III and IV).
  
  
  RESULTS
  The median time between problem identification and the beginning of treatment was 7 months. The subinterval with the largest delay was that between the first medical consultation and diagnosis (median, 4 months). Only 15% of the patients who had cancer were diagnosed with stage 0 and I disease, and 48% were diagnosed with stage III and IV disease. Multivariate analyses confirmed independent correlations for the means of problem identification, patient delay, health system delay, and age with a higher probability that patients would begin cancer treatment in an advanced stage.
  
  
  CONCLUSIONS
  In the sample studied, the majority of patients with breast cancer began treatment after a delay. Both patient delays and provider delays were associated with advanced disease. Research aimed at identifying specific access barriers to medical services is much needed to guide the design of tailored health policies that go beyond the promotion of breast care awareness and screening participation to include improvements in health services that facilitate access to timely diagnosis and treatment.
authors: Unit of Epidemiology, Instituto Nacional de Cancerología, Mexico City, Mexico.
authors: Karla
authors: K
authors: Unger-Saldaña
authors: Economics Division, Centro de Investigación y Docencia Económicas (CIDE), Mexico City, Mexico.
authors: Alfonso
authors: A
authors: Miranda
authors: Oncology Hospital, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico.
authors: Gelasio
authors: G
authors: Zarco-Espinosa
authors: Breast Tumors Department, Clínica de Ginecología y Obstetricia Número 4 del Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico.
authors: Fernando
authors: F
authors: Mainero-Ratchelous
authors: Breast Tumors Department, Instituto Nacional de Cancerología, Mexico City, Mexico.
authors: Enrique
authors: E
authors: Bargalló-Rocha
authors: Medical Oncology Unit, Hospital General de México, Mexico City, Mexico.
authors: Jesús
authors: J
authors: Miguel Lázaro-León
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D003695:Delivery of Health Care / Q000458:organization & administration; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D009367:Neoplasm Staging; D061665:Time-to-Treatment / Q000706:statistics & numerical data*
keywords: breast cancer; clinical stage; delay; early diagnosis; time intervals