Causes of physician delay in the diagnosis of breast cancer.

BACKGROUND

Understanding sources of physician delay in diagnosis of breast cancer will assist efforts to expedite diagnosis.

OBJECTIVE

To test whether increased reliance on screening mammography has affected causes of physician delay in diagnosis of breast cancer.

DESIGN

Survey of delays in a case series.

SETTING

Practice specializing in breast diseases in a region with high use of screening mammography.

PATIENTS

Four hundred thirty-five consecutive patients treated for 454 breast cancers of any stage.

INTERVENTION

Customary patient care.

MAIN OUTCOME MEASURES

Whether delay was related to how cancer was identified, patient age, individual cancer characteristics (such as tumor type), mammography reports, or physician expertise.

RESULTS

Twenty-one women (5%) were inappropriately reassured that a malignant lump was benign without biopsy, 14 women (3%) had a misread mammogram, 4 women (1%) had a misread pathologic finding, and 5 women (1%) had cancer missed by a poorly performed fine-needle aspiration biopsy. Delay was associated with a benign mammography report (relative risk, 10.8; 95% confidence interval, 5.1-22.8), a woman finding her own mass (relative risk, 3.3; 95% confidence interval, 1.8-6.2), and current hormone replacement therapy (relative risk, 3.1; 95% confidence interval, 1.2-8.5).

CONCLUSIONS

The leading cause of physician delay in diagnosis of breast cancer continues to be inappropriate reassurance that a mass is benign without biopsy. Reducing delay in diagnosis will require less willingness to rely on clinical examination to decide that a mass is benign, less reliance on benign mammography reports to decide not to biopsy a mass, and a requirement that fine-needle aspiration biopsy be done by persons with demonstrated competence for the procedure.