Cancer. 1986 Oct 15;58(8):1756-61. doi: 10.1002/1097-0142(19861015)58:8<1756::aid-cncr2820580829>3.0.co;2-v.
A detailed examination of the diagnostic process of 1110 newly diagnosed breast cancer patients first seen at 63 Italian general hospitals showed that 36% of them were diagnosed more than 3 months after the appearance of the first symptom. Whereas 17% (108/633) of the women with less than or equal to 3 months delay were Stage III and IV, the corresponding proportion among women with greater than 3 months delay was 32% (101/320), suggesting that 15% of advanced cases can be attributed to diagnostic delay. A 9% gain in survival at 5 years (66% vs. 57%) could be postulated if reported figures on mortality by stage are applied to our patients with less than or equal to 3 months delay compared to those with greater than 3 months. Moreover, examining the two components of delay (first symptom-first visit and first visit-final diagnosis) our data suggest that the potential benefits of timely presentation were, for some patients, cancelled by delays arising in the health care system. Breast self-examination (BSE) was practiced by 34% of the total population, but only 9% did it on a regular monthly basis. Although any type of BSE (regular and irregular) was associated with a smaller primary at presentation, a limited benefit of the procedure in terms of nodal involvement and pathologic stage of disease was evident only among regular BSE performers.
对1110例在63家意大利综合医院初诊的新确诊乳腺癌患者的诊断过程进行详细检查发现，其中36%的患者在出现首个症状3个月后才被确诊。初诊延迟小于或等于3个月的女性中17%（108/633）为Ⅲ期和Ⅳ期，而初诊延迟大于3个月的女性中这一比例为32%（101/320），这表明15%的晚期病例可归因于诊断延迟。如果将按分期报告的死亡率数据应用于初诊延迟小于或等于3个月的患者与大于3个月的患者相比，推测5年生存率可提高9%（66%对57%）。此外，通过分析延迟的两个组成部分（首个症状 - 首次就诊和首次就诊 - 最终诊断），我们的数据表明，对于一些患者而言，及时就诊的潜在益处被医疗系统中出现的延迟抵消了。34%的总人群进行过乳房自我检查（BSE），但只有9%的人每月定期进行。尽管任何类型的BSE（定期和不定期）都与初诊时较小的原发肿瘤相关，但仅在定期进行BSE的人群中，该检查在淋巴结受累和疾病病理分期方面的益处有限。
