title: Can we make a portrait of women with inoperable locally advanced breast cancer?
abstract: BACKGROUND
  Delay between clinical presentation and treatment of breast cancer (BC) can significantly impact mortality. We aimed at drawing a picture of women with locally advanced breast cancer (LABC) treated at our Breast Unit and at investigating factors associated with treatment delay.
  
  
  METHODS
  A retrospective descriptive analysis, using a specific 28-item semi-structured questionnaire, was conducted in 67 patients diagnosed with T4 BC.
  
  
  RESULTS
  Nearly a third of our patients had at least one known predisposing factor for LABC. 42% of patients did not perform routine medical breast checks, 49% reported indifference as the first feeling and 47% waited at least 3 months before seeking medical attention. The reasons for diagnostic delay were different in the various age groups. Doctor's delay in making the right diagnosis occurred in 60% of younger patients (≤40 years, n = 5), whereas among women aged 41-69years (n = 34) 50% suffered from psychiatric comorbidities. In patients ≥70 years (n = 28) social factors such as isolation, being widowed and living in a retirement home were present in most of the cases. Delay in seeking medical care was also associated with increasing age. Across all age groups, coping factors such as denial and indifference were also associated with an increase in the odds of delayed presentation, as opposed to fear.
  
  
  CONCLUSIONS
  Factors possibly explaining late medical consultation seem to differ according to age. Psychological factors are crucial in patients' delay whereas age and social factors are relevant in doctors' and system's delay.
authors.affiliation: Department of Obstetrics and Gynecology, Ente Ospedaliero Cantonale, Lugano, Switzerland; Breast Unit of Southern Switzerland (CSSI), Lugano, Switzerland. Electronic address: giacomo.montagna@usb.ch.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Montagna
authors.affiliation: Psychiatric University Hospital (UPK), University Basel, Basel, Switzerland; Psychiatric Services Grisons (PDGR), Chur, Switzerland; Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences (AECOM), New York, NY, USA.
authors.forename: Andres R
authors.initials: AR
authors.lastname: Schneeberger
authors.affiliation: Breast Unit of Southern Switzerland (CSSI), Lugano, Switzerland; Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Rossi
authors.affiliation: Breast Unit of Southern Switzerland (CSSI), Lugano, Switzerland.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Bianchi Micheli
authors.affiliation: Department of Obstetrics and Gynecology, Ente Ospedaliero Cantonale, Lugano, Switzerland; Breast Unit of Southern Switzerland (CSSI), Lugano, Switzerland.
authors.forename: Francesco
authors.initials: F
authors.lastname: Meani
authors.affiliation: Department of Laboratory Medicine, Ente Ospedaliero Cantonale, Lugano, Switzerland.
authors.forename: Mauro
authors.initials: M
authors.lastname: Imperiali
authors.affiliation: Ticino Cancer Registry, Locarno, Switzerland.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Spitale
authors.affiliation: Breast Unit of Southern Switzerland (CSSI), Lugano, Switzerland; Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland.
authors.forename: Olivia
authors.initials: O
authors.lastname: Pagani
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000523:psychology*; D057210:Delayed Diagnosis / Q000523:psychology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D012189:Retrospective Studies; D013997:Time Factors; D061665:Time-to-Treatment
keywords: Coping factors; Denial; Diagnostic delay; LABC; Patient delay; Psychosocial factors; Treatment delay