Graduate School, Khon Kaen University.
J Epidemiol. 2014;24(2):102-8. doi: 10.2188/jea.je20130090. Epub 2013 Dec 14.
We identified factors associated with delayed first consultation for breast symptoms (patient delay), delayed diagnosis after first consultation (doctor delay), and advanced pathologic stage at presentation among 180 women with breast cancer in Thailand.
In this cross-sectional study 180 patients with invasive breast cancer were interviewed about potential risk factors and markers of delayed presentation. Patient delay was defined as time from onset of symptoms to first consultation with a health care provider, and doctor delay was defined as time from first consultation with a health care provider to diagnosis of breast cancer. Linear regression and logistic regression were used for the data analyses.
Among the 180 patients, 17% delayed seeking consultation for longer than 3 months, and 42% reported a doctor delay of longer than 3 months. In multivariate linear analysis, a significant increase in patient delay was associated with higher family income and smoking; factors associated with increased doctor delay were previous breast symptoms, self-treatment, and travel time to the hospital. In multiple logistic regression, doctor delay was related to age at first birth (P = 0.003), previous breast symptoms (P = 0.01), and number of consultations with a surgeon before diagnosis (P = 0.007). Regarding stage of breast cancer, there were significant associations with age at diagnosis (P for trend = 0.04), education (P for trend = 0.01), family income (P for trend = 0.02), time to referral (P = 0.01), and number of consultations with a surgeon before diagnosis (P < 0.01).
Hospital referral from a health care provider was a major contributor to delayed diagnosis. Breast cancer awareness campaigns in Thailand should target individuals in low- and high-income groups, as well as practitioners.
我们在泰国的 180 名乳腺癌患者中确定了与乳房症状首次就诊延迟（患者延迟）、首次就诊后诊断延迟（医生延迟）以及就诊时病理分期较晚相关的因素。
在这项横断面研究中，对 180 名浸润性乳腺癌患者进行了访谈，询问了潜在的发病因素和就诊延误标志物。患者延迟定义为从症状出现到首次就诊于医疗机构的时间，医生延迟定义为从首次就诊于医疗机构到诊断为乳腺癌的时间。采用线性回归和逻辑回归进行数据分析。
在 180 名患者中，17%的患者延迟就诊超过 3 个月，42%的患者报告医生延迟超过 3 个月。多元线性分析显示，患者延迟显著增加与家庭收入较高和吸烟有关；与医生延迟增加相关的因素是以前的乳房症状、自我治疗和到医院的旅行时间。在多变量逻辑回归中，医生延迟与初产妇年龄（P = 0.003）、以前的乳房症状（P = 0.01）和诊断前与外科医生就诊次数（P = 0.007）有关。关于乳腺癌分期，与诊断时年龄（P 趋势= 0.04）、教育程度（P 趋势= 0.01）、家庭收入（P 趋势= 0.02）、转诊时间（P = 0.01）和诊断前与外科医生就诊次数（P < 0.01）显著相关。
医疗机构的医院转诊是导致诊断延迟的主要原因。泰国的乳腺癌防治宣传活动应针对高收入和低收入人群以及从业者。
