Differences Between Black and White Women With Breast Cancer in Time From Symptom Recognition to Medical Consultation

Coates, Ralph J.; Bransfield, Diana D.; Wesley, Margaret N.; Hankey, Benjamin F.; Eley, J. William; Greenberg, Raymond S.; Flanders, Dana; Hunter, Carrie P.; Edwards, Brenda K.; Forman, Myron; Chen, V. W.; Reynolds, Peggy; Boyd, Peggy; Austin, D E; Muss, H. B.; Blacklow, Robert S.

doi:10.1093/jnci/84.12.938

Cited by 101 publications

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“…This finding is likely to reflect the generally younger age of ethnic minorities in Britain (Office for National Statistics, 1996). It is consistent with observations in ethnic minority groups both in the UK and the USA (African-American women) (Coates et al, 1992;Elmore et al, 1998;Joslyn and West, 2000;Dos Santos Silva et al, 2003;Smith et al, 2003).…”

Section: Discussionsupporting

confidence: 92%

Breast cancer outcomes in South Asian population of West Yorkshire

et al. 2004

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Section: Discussionsupporting

confidence: 92%

Breast cancer outcomes in South Asian population of West Yorkshire

et al. 2004

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“…Downplaying the significance of breast related symptoms seems to represent a major cause for delay, whereas fear and difficulties in scheduling an appointment appear to play a minor role in this context. This finding is similar to an earlier report by Coates et al (1992), where delay was substantially caused by naive perception regarding the vital significance of breast cancer symptoms.…”

Section: Discussionsupporting

confidence: 91%

“…This is in agreement with findings from pertinent studies published during the last decade (Coates et al, 1992;Afzelius et al, 1994;Burgess et al, 1998) and is further evidence of a favourable trend towards shorter delay during the last two decades when compared with earlier studies (Cameron and Hinton, 1968;Dennis et al, 1975;Fisher et al, 1977;Elwood and Moorehead, 1980;MacArthur and Smith, 1981;Dohrmann et al, 1982;Vernon et al, 1985;Neale et al, 1986). This trend might be attributable to an increasing health awareness among women due to extensive information campaigns which address breast cancer warning signs in many developed countries.…”

Section: Discussionsupporting

confidence: 90%

“…Similar findings have been reported from various countries (Polednak, 1986;Yancik et al, 1989;Coates et al, 1992;Afzelius et al, 1994;Fowble et al, 1994;Ramirez et al, 1999). Several explanations why patient delay is more often found among older women have been suggested.…”

Section: Discussionsupporting

confidence: 87%

“…Although women who undergo breast cancer screening tend to be more health conscious, they might feel less worried about some vague alterations of the breast if the last mammography or clinical examination had been normal. Other studies show no clear evidence of an association between lack of breast self examination and patient delay (Huguley et al, 1988;Coates et al, 1992;Burgess et al, 1998).…”

Section: Clinicalmentioning

confidence: 90%

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Patient delay and stage of diagnosis among breast cancer patients in Germany – a population based study

et al. 2002

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Early diagnosis is a tenet in oncology and should enable early treatment with the expectation of improved outcome. Extent and determinants of patient delay of diagnosis in breast cancer patients and its impact on stage of disease were examined in a population based study among female breast cancer patients in Germany. Two hundred and eighty-seven women, aged 18 to 80 years with newly diagnosed invasive symptomatic breast cancer, were interviewed with respect to the diagnostic process. Patient delay was defined as time from onset of first symptoms to first consultation of a doctor. Median patient delay was 16 days among symptomatic patients. Eighteen per cent of all breast cancer patients waited longer than 3 months before consulting a physician. Long patient delay was associated with old age, history of a benign mastopathy, obesity, and indices of health behaviour such as not knowing a gynaecologist for out-patient care and non-participation in general health screening examinations. A strong association between patient delay and stage at diagnosis was observed for poorly differentiated tumours. These results suggest that at risk groups for delaying consultation can be identified and that a substantial proportion of late stage diagnoses of poorly differentiated breast cancer cases could be avoided if all patients with breast cancer symptoms would present to a doctor within 1 month.

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Diagnostic Delay in Breast Disease

Wall¹,

Moore²,

El‐Tamer³

et al. 1998

Arch Surg

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Objective: To analyze the diagnostic process in 146 women referred to a breast clinic in an urban setting between Design: We devised the "diagnostic delay index (DDI)," defined as the time between the medical system's awareness of a diagnostic need and the completion of the diagnostic process. The time awaiting breast clinic consultation and the diagnostic events experiencedincluding clinic visits, imaging studies, and biopsieswere recorded. We stratified patients in 2 pathways (palpable masses and mammogram-identified lesions) and by benign or malignant outcome.Results: Patients in pathways 1 (n = 85) and 2 (n=61) had a mean (±SD) DDI of 68.4 (±46.9) days and 71.9 (±35.2) days, respectively. Patients in both pathways who had a malignant outcome had a significantly lower DDI than those who had a benign outcome (47.5±30.9 days vs 78.6±42.6) (PϽ.001); this advantage was most pronounced in patients with palpable lumps. The average patient waited more than 3 weeks for both an initial clinic consultation and operating room access. Quartile analysis of the DDI revealed statistically significant differences in clinic access time, number of visits, diagnostic events per visit, and operating room access time. Regression analysis demonstrates the relationship between DDI and measured process variables: DDI= −21.11+0.09 age+1.86 pathway − 12.18 outcome+1.08 clinic access+11.91 visits+0.94 operating room access (R 2 =61.5%). Conclusions:In a public hospital, diagnostic delay is related to inadequate access to surgical consultation and a delay in operating room access. Regression analysis demonstrates the relationships between these components of system diagnostic delay and suggests strategies for reducing the DDI.

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Differences Between Black and White Women With Breast Cancer in Time From Symptom Recognition to Medical Consultation

Abstract: This small difference in the time from symptom recognition to medical consultation is unlikely to account for the large racial differences in survival rates and in stage of disease at the time of diagnosis.

Cited by 101 publications

References 0 publications

Breast cancer outcomes in South Asian population of West Yorkshire

Breast cancer outcomes in South Asian population of West Yorkshire

Patient delay and stage of diagnosis among breast cancer patients in Germany – a population based study

Diagnostic Delay in Breast Disease

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