Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, ON, Canada.
ICES Queen's, Kingston, ON, Canada.
Breast Cancer Res Treat. 2021 May;187(1):225-235. doi: 10.1007/s10549-020-06051-0. Epub 2021 Jan 24.
A prolonged time from first presentation to cancer diagnosis has been associated with worse disease-related outcomes. This study evaluated potential determinants of a long diagnostic interval among symptomatic breast cancer patients.
This was a population-based, cross-sectional study of symptomatic breast cancer patients diagnosed in Ontario, Canada from 2007 to 2015 using administrative health data. The diagnostic interval was defined as the time from the earliest breast cancer-related healthcare encounter before diagnosis to the diagnosis date. Potential determinants of the diagnostic interval included patient, disease and usual healthcare utilization characteristics. We used multivariable quantile regression to evaluate their relationship with the diagnostic interval. We also examined differences in diagnostic interval by the frequency of encounters within the interval.
Among 45,967 symptomatic breast cancer patients, the median diagnostic interval was 41 days (interquartile range 20-92). Longer diagnostic intervals were observed in younger patients, patients with higher burden of comorbid disease, recent immigrants to Canada, and patients with higher healthcare utilization prior to their diagnostic interval. Shorter intervals were observed in patients residing in long-term care facilities, patients with late stage disease, and patients who initially presented in an emergency department. Longer diagnostic intervals were characterized by an increased number of physician visits and breast procedures.
The identification of groups at risk of longer diagnostic intervals provides direction for future research aimed at better understanding and improving breast cancer diagnostic pathways. Ensuring that all women receive a timely breast cancer diagnosis could improve breast cancer outcomes.
从首次就诊到癌症确诊的时间延长与较差的疾病相关结局相关。本研究评估了有症状乳腺癌患者中长诊断间隔的潜在决定因素。
这是一项基于人群的、回顾性研究，对 2007 年至 2015 年在加拿大安大略省被诊断为有症状乳腺癌的患者使用行政健康数据进行了研究。诊断间隔被定义为从诊断前最早的乳腺癌相关医疗保健就诊到诊断日期的时间。诊断间隔的潜在决定因素包括患者、疾病和常规医疗保健使用特征。我们使用多变量分位数回归来评估它们与诊断间隔的关系。我们还通过间隔内就诊的频率来检查诊断间隔的差异。
在 45967 名有症状的乳腺癌患者中，中位诊断间隔为 41 天（四分位间距 20-92）。年轻患者、合并症负担较高的患者、最近移民到加拿大的患者以及在诊断间隔之前医疗保健利用度较高的患者的诊断间隔较长。居住在长期护理设施中的患者、疾病晚期患者和最初在急诊科就诊的患者的间隔较短。较短的间隔特征是就诊次数和乳房检查次数增加。
确定处于较长诊断间隔风险中的群体为未来旨在更好地了解和改善乳腺癌诊断途径的研究提供了方向。确保所有女性都能及时接受乳腺癌诊断可以改善乳腺癌的结局。
