Effect of care-delivery delay on the survival of Mexican women with breast cancer

Abstract

Efecto de la demora en la atención sobre la supervivencia de mujeres mexicanas con cáncer de mama. Salud Publica Mex 2016;58:237-250. ResumenObjetivo. Estimar el efecto del tiempo de atención sobre la supervivencia de mujeres con cáncer de mama. Material y métodos. Se realizó el análisis retrospectivo de 854 mujeres atendidas en 11 hospitales entre 2007 y 2009. Se emplearon estimadores de Kaplan-Meier y un modelo de riesgos proporcionales de Cox. Resultados. 10.5% se diagnosticó en etapa I, mientras que 82.1% demoró más de 67 días entre la percepción de un síntoma y el inicio del tratamiento. La mediana del tiempo desde la entrega de los resultados de la mastografía hasta la biopsia fue de 31 días (RIQ 14-56); en comparación con quienes se encontraron en el cuartil 1 (Q1), la supervivencia fue menor en aquellas que se encontraron en los Q3 y Q4 (HR=1.68, IC95% 0.94-3.00; HR=1.76, IC95% 1.04-2.98, respectivamente). Conclusiones. Se sugiere reducir el tiempo desde la entrega de los resultados de la mastografía a la biopsia diagnóstica para incrementar la supervivencia.Palabras clave: cáncer de mama; demora en la atención; supervivencia; México The median time from receipt of results of the mammography to biopsy was 31 days (IQR 14-56). Compared with those who were in quartile I (Q1), survival was lower among those in Q3 and Q4 (HR=1.68, 95%CI 0.94-3.00; HR=1.76, 95% CI 1.04-2.98, respectively). Conclusions. To increase survival, it is suggested that the time between receipt of the mammography results and diagnostic biopsy be reduced.

Evaluation of delays in diagnosis and treatment of breast cancer in a reference center: a retrospective analysis

“…The main complaint -breast nodule (53% of cases) -and the most common histological subtype -infiltrating ductal carcinoma (85.5% of cases) -are similar to those found in other specialized studies 4,20 . Considering 139 patients who had information on the initial staging, the majority -110 women -were diagnosed with intermediate stages.…”

“…Upon analyzing 73 patients in the state of São Paulo, Trufelli et al 4 reported 17 cases of stage I, 28 cases of stage II, 17 case of stage III and 4 cases of stage IV. In a study by Angeles Llerenas et al 20 , in a Mexican multi-institutional analysis with 854 patients, this distribution was also similar: 88 cases of stage I, 324 cases of stage II, 342 cases of stage III and 62 cases of stage IV.…”

“…Another Brazilian study 23 , carried out in Vale do Cariri, Ceará, compares this waiting time to start treatment between private and public institutions. The mean time was significantly lower in the private institution (39 days) than in the public institution (71.5 days) (p = 0.031).In a Mexican study 20 , the mean treatment interval was 37 days.…”

“…The analysis of the delay in the diagnosis and treatment of breast cancer is always performed by retrospective studies, 4,20 similar to the present investigation, or by systematic reviews 8 . The ethical impediment for prospective studies is obvious for the subject, since it is not possible to randomize groups and wait for a malignant cancer to evolve.…”

Barriers and Explanatory Mechanisms of Delays in the Patient and Diagnosis Intervals of Care for Breast Cancer in Mexico

“…In Mexico, BC is the most common cause of cancer‐related mortality among women . Although data on the clinical stages of breast cancer are scarce and are not nationally representative, existing studies have reported that 45%–48% of cases are diagnosed in stages III and IV, and only between 10% and 20% in stages 0 and I . In a previous study, both patient delay and health system delay were found to be independently associated with increased probability of advanced BC among Mexican women .…”