Montella M, Crispo A, D'Aiuto G, De Marco M, de Bellis G, Fabbrocini G, Pizzorusso M, Tamburini M, Silvestra P
Department of Epidemiology, Fondazione G. Pascale, National Cancer Institute, Naples, Italy.
Eur J Cancer Prev. 2001 Feb;10(1):53-9. doi: 10.1097/00008469-200102000-00006.
Randomized trials of mammographic screening have provided strong evidence that early diagnosis and treatment of breast cancer can reduce the specific mortality. Moreover, in a recent systematic review of published studies, delays of 3-6 months between symptom onset and treatment have been clearly found to be associated with lower survival rates for breast cancer patients. The aim of this study was to examine delays registered among breast cancer patients in southern Italy, in order to recognize their determining factors so as to provide women with a better opportunity for survival. The variables examined were age (< 50, 50-64, > or = 65 years), education (< or = 5, > 5 school years); symptom status at first presentation (symptomatic or asymptomatic); date of first symptom presentation; date of first consultation with a health provider; the type of health provider consulted; tumour size and nodal status according to the pTNM system. Time intervals were categorized into: < 1 month, 1-3 months and > 3 months for patient and medical delay; 1-3 months, 3-6 months, > 6 months for overall delay. Patient delay was associated with age and education: a higher risk was found for women of over 65 years age (odds ratio (OR) 2.1, 95% confidence interval (CI) 1.2-3.5) and with < or = 5 years school attendance (OR 3.3, 95% CI 2.0-5.6). Medical delay was seen to be associated with the professional figure: significant differences were found between senologists (oncologists exclusively dedicated to breast cancer operation) and other specialists (OR 3.5, 95% CI 1.5-8.4). Young age and symptomatic presentation were found to be high risk factors. Concerning tumour size in overall delay, in cases where the tumour was > 2 cm the OR was 2.4 (95% CI 1.5-3.7). Our study suggests that diagnostic delay can be reduced by providing more efficient training programmes for members of the medical profession and by producing educational training programmes targeted specifically at each age category (i.e. in older women more attention to education in prevention; in younger women correct information about mammography and specialized structures).
乳房X光筛查随机试验提供了有力证据，证明乳腺癌的早期诊断和治疗可降低特定死亡率。此外，在最近一项对已发表研究的系统评价中，明确发现症状出现与治疗之间延迟3至6个月与乳腺癌患者较低的生存率相关。本研究的目的是调查意大利南部乳腺癌患者中记录的延迟情况，以识别其决定因素，从而为女性提供更好的生存机会。所研究的变量包括年龄（<50岁、50 - 64岁、≥65岁）、教育程度（≤5学年、>5学年）；首次就诊时的症状状态（有症状或无症状）；首次出现症状的日期；首次咨询医疗服务提供者的日期；咨询的医疗服务提供者类型；根据pTNM系统确定的肿瘤大小和淋巴结状态。时间间隔分为：患者延迟和医疗延迟的<1个月、1 - 3个月和>3个月；总延迟的1 - 3个月、3 - 6个月、>6个月。患者延迟与年龄和教育程度相关：65岁以上女性风险更高（优势比（OR）2.1，95%置信区间（CI）1.2 - 3.5），且上学年限≤5年者风险更高（OR 3.3，95% CI 2.0 - 5.6）。医疗延迟与专业人员相关：乳腺科医生（专门从事乳腺癌手术的肿瘤学家）与其他专科医生之间存在显著差异（OR 3.5，95% CI 1.5 - 8.4）。年轻和有症状表现被发现是高风险因素。关于总延迟中的肿瘤大小，肿瘤>2 cm的病例中OR为2.4（95% CI 1.5 - 3.7）。我们的研究表明，通过为医疗行业人员提供更有效的培训计划以及制定专门针对每个年龄组的教育培训计划（即老年女性更多关注预防教育；年轻女性提供关于乳房X光检查和专业机构的正确信息），可以减少诊断延迟。
