title: Factors related to breast cancer detection mode and time to diagnosis in Alberta, Canada: a population-based retrospective cohort study.
abstract: BACKGROUND
  Understanding the factors affecting the mode and timeliness of breast cancer diagnosis is important to optimizing patient experiences and outcomes. The purposes of the study were to identify factors related to the length of the diagnostic interval and assess how they vary by mode of diagnosis: screen or symptom detection.
  
  
  METHODS
  All female residents of Alberta diagnosed with first primary breast cancer in years 2004-2010 were identified from the Alberta Cancer Registry. Data were linked to Physician Claims and screening program databases. Screen-detected patients were identified as having a screening mammogram within 6-months prior to diagnosis; remaining patients were considered symptom-detected. Separate quantile regression was conducted for each detection mode to assess the relationship between demographic/clinical and healthcare factors.
  
  
  RESULTS
  Overall, 38 % of the 12,373 breast cancer cases were screen-detected compared to 47 % of the screen-eligible population. Health region of residence was strongly associated with cancer detection mode. The median diagnostic interval for screen and symptom-detected cancers was 19 and 21 days, respectively. The variation by health region, however, was large ranging from an estimated median of 4 to 37 days for screen-detected patients and from 17 to 33 days for symptom-detected patients. Cancer stage was inversely associated with the diagnostic interval for symptom-detected cancers, but not for screen-detected cancers.
  
  
  CONCLUSIONS
  Significant variation by health region in both the percentage of women with screen-detected cancer and the length of the diagnostic interval for screen and symptom-detected breast cancers suggests there could be important differences in local breast cancer diagnostic care coordination.
authors.affiliation: School of Public Health, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada.
authors.forename: Yan
authors.initials: Y
authors.lastname: Yuan
authors.affiliation: School of Public Health, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada.
authors.forename: Maoji
authors.initials: M
authors.lastname: Li
authors.affiliation: Cancer Control Alberta, Alberta Health Services, Edmonton, Alberta, T5J 3H1, Canada.
authors.forename: Jing
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Diagnostic Imaging, Foothills Medical Centre, Calgary, Alberta, T2N 2T9, Canada.
authors.forename: Tracy
authors.initials: T
authors.lastname: Elliot
authors.affiliation: Department of Surgery, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada.
authors.forename: Kelly
authors.initials: K
authors.lastname: Dabbs
authors.affiliation: Family Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, T2N 4N1, Canada.
authors.forename: James A
authors.initials: JA
authors.lastname: Dickinson
authors.affiliation: School of Public Health, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada.
authors.forename: Stacey
authors.initials: S
authors.lastname: Fisher
authors.affiliation: Divison of General Medical Disciplines, Stanford University School of Medicine, Stanford, CA, 94305, USA. mwinget@stanford.edu.
authors.forename: Marcy
authors.initials: M
authors.lastname: Winget
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000416:Alberta; D001943:Breast Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D012107:Research Design; D012189:Retrospective Studies; D061665:Time-to-Treatment