title: The Impact of Rurality and Disadvantage on the Diagnostic Interval for Breast Cancer in a Large Population-Based Study of 3202 Women in Queensland, Australia.
abstract: Delays in diagnosing breast cancer (BC) can lead to poorer outcomes. We investigated factors related to the diagnostic interval in a population-based cohort of 3202 women diagnosed with BC in Queensland, Australia. Interviews ascertained method of detection and dates of medical/procedural appointments, and clinical information was obtained from medical records. Time intervals were calculated from self-recognition of symptoms (symptom-detected) or mammogram (screen-detected) to diagnosis (diagnostic interval (DI)). The cohort included 1560 women with symptom-detected and 1642 with screen-detected BC. Symptom-detected women had higher odds of DI of >60 days if they were Indigenous (OR = 3.12, 95% CI = 1.40, 6.98); lived in outer regional (OR = 1.50, 95% CI = 1.09, 2.06) or remote locations (OR = 2.46, 95% CI = 1.39, 4.38); or presented with a "non-lump" symptom (OR = 1.84, 95% CI = 1.43, 2.36). For screen-detected BC, women who were Indigenous (OR = 2.36, 95% CI = 1.03, 5.80); lived in remote locations (OR = 2.35, 95% CI = 1.24, 4.44); or disadvantaged areas (OR = 1.69, 95% CI = 1.17, 2.43) and attended a public screening facility (OR = 2.10, 95% CI = 1.40, 3.17) had higher odds of DI > 30 days. Our study indicates a disadvantage in terms of DI for rural, disadvantaged and Indigenous women. Difficulties in accessing primary care and diagnostic services are evident. There is a need to identify and implement an efficient and effective model of care to minimize avoidable longer diagnostic intervals.
authors.affiliation: Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia. pipyoul@cancerqld.org.au.|Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia. pipyoul@cancerqld.org.au.|School of Public Health and Social Work, Queensland University of Technology, Herston Road, Kelvin Grove, QLD 4059, Australia. pipyoul@cancerqld.org.au.
authors.forename: Philippa H
authors.initials: PH
authors.lastname: Youl
authors.affiliation: Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia. joanneaitken@cancerqld.org.au.|School of Public Health and Social Work, Queensland University of Technology, Herston Road, Kelvin Grove, QLD 4059, Australia. joanneaitken@cancerqld.org.au.|School of Population Health, University of Queensland, Brisbane, QLD 4072, Australia. joanneaitken@cancerqld.org.au.|Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD 4350, Australia. joanneaitken@cancerqld.org.au.
authors.forename: Joanne F
authors.initials: JF
authors.lastname: Aitken
authors.affiliation: Institute of Health and Ageing, Australian Catholic University, Fitzroy, VIC 3115, Australia. Gavin.Turrell@acu.edu.au.
authors.forename: Gavin
authors.initials: G
authors.lastname: Turrell
authors.affiliation: Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia. suzanne.chambers@griffith.edu.au.|Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia. suzanne.chambers@griffith.edu.au.|Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD 4350, Australia. suzanne.chambers@griffith.edu.au.
authors.forename: Suzanne K
authors.initials: SK
authors.lastname: Chambers
authors.affiliation: Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia. jeffdunn@cancerqld.org.au.|Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia. jeffdunn@cancerqld.org.au.|Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD 4350, Australia. jeffdunn@cancerqld.org.au.|School of Social Science, University of Queensland, Brisbane, QLD4072, Australia. jeffdunn@cancerqld.org.au.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Dunn
authors.affiliation: Mater Medical Centre, 293 Vulture Street, South Brisbane, QLD 4101, Australia. c_pyke@mc.mater.org.au.
authors.forename: Christopher
authors.initials: C
authors.lastname: Pyke
authors.affiliation: Cancer Council Queensland, P.O. Box 201, Spring Hill, QLD 4004, Australia. peterbaade@cancerqld.org.au.|Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia. peterbaade@cancerqld.org.au.|School of Mathematical Sciences, Queensland University of Technology, Gardens Point, Brisbane, QLD 4000, Australia. peterbaade@cancerqld.org.au.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Baade
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D015331:Cohort Studies; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008137:Longitudinal Studies; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio; D011793:Queensland; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013997:Time Factors; D035862:Vulnerable Populations / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: breast cancer; delay; diagnosis; health system; inequalities; rurality