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. 1999 Feb;79(5-6):858–864. doi: 10.1038/sj.bjc.6690137

The influence on survival of delay in the presentation and treatment of symptomatic breast cancer

M A Richards 1, P Smith 1, A J Ramirez 1, I S Fentiman 1, R D Rubens 1
PMCID: PMC2362673  PMID: 10070881

Abstract

The aim of this study was to examine the possible influence on survival of delays prior to presentation and/or treatment among women with breast cancer. Duration of symptoms prior to hospital referral was recorded for 2964 women who presented with any stage of breast cancer to Guy's Hospital between 1975 and 1990. Median follow-up is 12.5 years. The impact of delay (defined as having symptoms for 12 or more weeks) on survival was measured from the date of diagnosis and from the date when the patient first noticed symptoms to control for lead-time bias. Thirty-two per cent (942/2964) of patients had symptoms for 12 or more weeks before their first hospital visit and 32% (302/942) of patients with delays of 12 or more weeks had locally advanced or metastatic disease, compared with only 10% (210/2022) of those with delays of less than 12 weeks (P< 0.0001). Survival measured both from the date of diagnosis (P< 0.001) and from the onset of the patient's symptoms (P= 0.003) was worse among women with longer delays. Ten years after the onset of symptoms, survival was 52% for women with delays less than 12 weeks and 47% for those with longer delays. At 20 years the survival rates were 34% and 24% respectively. Furthermore, patients with delays of 12–26 weeks had significantly worse survival rates than those with delays of less than 12 weeks. Multivariate analyses indicated that the adverse impact of delay in presentation on survival was attributable to an association between longer delays and more advanced stage. However, within individual stages, longer delay had no adverse impact on survival. Analyses based on ‘total delay’ (i.e. the interval between a patient first noticing symptoms and starting treatment) yielded very similar results in terms of survival to those based on delay to first hospital visit (delay in presentation). © 1999 Cancer Research Campaign

Keywords: breast cancer, delay, duration of symptoms, survival

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Selected References

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  1. Afzelius P., Zedeler K., Sommer H., Mouridsen H. T., Blichert-Toft M. Patient's and doctor's delay in primary breast cancer. Prognostic implications. Acta Oncol. 1994;33(4):345–351. doi: 10.3109/02841869409098427. [DOI] [PubMed] [Google Scholar]
  2. Alderson M. R., Hamlin I., Staunton M. D. The relative significance of prognostic factors in breast carcinoma. Br J Cancer. 1971 Dec;25(4):646–656. doi: 10.1038/bjc.1971.80. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. BLOOM H. J., RICHARDSON W. W. Histological grading and prognosis in breast cancer; a study of 1409 cases of which 359 have been followed for 15 years. Br J Cancer. 1957 Sep;11(3):359–377. doi: 10.1038/bjc.1957.43. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Burgess C. C., Ramirez A. J., Richards M. A., Love S. B. Who and what influences delayed presentation in breast cancer? Br J Cancer. 1998 Apr;77(8):1343–1348. doi: 10.1038/bjc.1998.224. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Charlson M. E. Delay in the treatment of carcinoma of the breast. Surg Gynecol Obstet. 1985 May;160(5):393–399. [PubMed] [Google Scholar]
  6. Dennis C. R., Gardner B., Lim B. Analysis of survival and recurrence vs. patient and doctor delay in treatment of breast cancer. Cancer. 1975 Mar;35(3):714–720. doi: 10.1002/1097-0142(197503)35:3<714::aid-cncr2820350326>3.0.co;2-v. [DOI] [PubMed] [Google Scholar]
  7. Elwood J. M., Moorehead W. P. Delay in diagnosis and long-term survival in breast cancer. Br Med J. 1980 May 31;280(6227):1291–1294. doi: 10.1136/bmj.280.6227.1291. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Facione N. C. Delay versus help seeking for breast cancer symptoms: a critical review of the literature on patient and provider delay. Soc Sci Med. 1993 Jun;36(12):1521–1534. doi: 10.1016/0277-9536(93)90340-a. [DOI] [PubMed] [Google Scholar]
  9. Feldman J. G., Saunders M., Carter A. C., Gardner B. The effects of patient delay and symptoms other than a lump on survival in breast cancer. Cancer. 1983 Apr 1;51(7):1226–1229. doi: 10.1002/1097-0142(19830401)51:7<1226::aid-cncr2820510709>3.0.co;2-k. [DOI] [PubMed] [Google Scholar]
  10. Fentiman I. S., Howell A., Hamed H., Lee S. M., Ranson M., Wall J., Chaudary M. A., Ash C. M., Gregory W. M., Sellwood R. A. A controlled trial of adjuvant tamoxifen, with or without prednisolone, in post-menopausal women with operable breast cancer. Br J Cancer. 1994 Oct;70(4):729–731. doi: 10.1038/bjc.1994.384. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Fisher E. R., Redmond C., Fisher B. A perspective concerning the relation of duration of symptoms to treatment failure in patients with breast cancer. Cancer. 1977 Dec;40(6):3160–3167. doi: 10.1002/1097-0142(197712)40:6<3160::aid-cncr2820400661>3.0.co;2-p. [DOI] [PubMed] [Google Scholar]
  12. Huguley C. M., Jr, Brown R. L., Greenberg R. S., Clark W. S. Breast self-examination and survival from breast cancer. Cancer. 1988 Oct 1;62(7):1389–1396. doi: 10.1002/1097-0142(19881001)62:7<1389::aid-cncr2820620725>3.0.co;2-0. [DOI] [PubMed] [Google Scholar]
  13. Kern K. A. Medicolegal analysis of the delayed diagnosis of cancer in 338 cases in the United States. Arch Surg. 1994 Apr;129(4):397–404. doi: 10.1001/archsurg.1994.01420280073009. [DOI] [PubMed] [Google Scholar]
  14. MacArthur C., Smith A. Delay in breast cancer and the nature of presenting symptoms. Lancet. 1981 Mar 14;1(8220 Pt 1):601–603. doi: 10.1016/s0140-6736(81)92044-4. [DOI] [PubMed] [Google Scholar]
  15. Machiavelli M., Leone B., Romero A., Perez J., Vallejo C., Bianco A., Rodriguez R., Estevez R., Chacon R., Dansky C. Relation between delay and survival in 596 patients with breast cancer. Oncology. 1989;46(2):78–82. doi: 10.1159/000226689. [DOI] [PubMed] [Google Scholar]
  16. Neave L. M., Mason B. H., Kay R. G. Does delay in diagnosis of breast cancer affect survival? Breast Cancer Res Treat. 1990 Feb;15(2):103–108. doi: 10.1007/BF01810782. [DOI] [PubMed] [Google Scholar]
  17. Raabe N. K., Fossaa S. D. Primary invasive breast carcinoma in Oslo 1980-1989. Incidence and delay. Acta Oncol. 1996;35(1):9–15. doi: 10.3109/02841869609098473. [DOI] [PubMed] [Google Scholar]
  18. Richards M. A., O'Reilly S. M., Howell A., George W. D., Fentiman I. S., Chaudary M. A., Crowther D., Rubens R. D. Adjuvant cyclophosphamide, methotrexate, and fluorouracil in patients with axillary node-positive breast cancer: an update of the Guy's/Manchester trial. J Clin Oncol. 1990 Dec;8(12):2032–2039. doi: 10.1200/JCO.1990.8.12.2032. [DOI] [PubMed] [Google Scholar]
  19. Richardson J. L., Langholz B., Bernstein L., Burciaga C., Danley K., Ross R. K. Stage and delay in breast cancer diagnosis by race, socioeconomic status, age and year. Br J Cancer. 1992 Jun;65(6):922–926. doi: 10.1038/bjc.1992.193. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Rossi S., Cinini C., Di Pietro C., Lombardi C. P., Crucitti A., Bellantone R., Crucitti F. Diagnostic delay in breast cancer: correlation with disease stage and prognosis. Tumori. 1990 Dec 31;76(6):559–562. doi: 10.1177/030089169007600609. [DOI] [PubMed] [Google Scholar]
  21. Rubens R. D., Armitage P., Winter P. J., Tong D., Hayward J. L. Prognosis in inoperable stage III carcinoma of the breast. Eur J Cancer. 1977 Aug;13(8):805–811. doi: 10.1016/0014-2964(77)90134-7. [DOI] [PubMed] [Google Scholar]
  22. Rubens R. D., Bartelink H., Engelsman E., Hayward J. L., Rotmensz N., Sylvester R., van der Schueren E., Papadiamantis J., Vassilaros S. D., Wildiers J. Locally advanced breast cancer: the contribution of cytotoxic and endocrine treatment to radiotherapy. An EORTC Breast Cancer Co-operative Group Trial (10792). Eur J Cancer Clin Oncol. 1989 Apr;25(4):667–678. doi: 10.1016/0277-5379(89)90203-4. [DOI] [PubMed] [Google Scholar]
  23. Rubens R. D., Hayward J. L., Knight R. K., Bulbrook R. D., Fentiman I. S., Chaudary M., Howell A., Bush H., Crowther D., Sellwood R. A. Controlled trial of adjuvant chemotherapy with melphalan for breast cancer. Lancet. 1983 Apr 16;1(8329):839–843. doi: 10.1016/s0140-6736(83)91385-5. [DOI] [PubMed] [Google Scholar]
  24. Rubens R. D., Sexton S., Tong D., Winter P. J., Knight R. K., Hayward J. L. Combined chemotherapy and radiotherapy for locally advanced breast cancer. Eur J Cancer. 1980 Mar;16(3):351–356. doi: 10.1016/0014-2964(80)90352-7. [DOI] [PubMed] [Google Scholar]
  25. Sheridan B., Fleming J., Atkinson L., Scott G. The effects of delay in treatment of survival rates in carcinoma of the breast. Med J Aust. 1971 Jan 30;1(5):262–267. [PubMed] [Google Scholar]
  26. Vernon S. W., Tilley B. C., Neale A. V., Steinfeldt L. Ethnicity, survival, and delay in seeking treatment for symptoms of breast cancer. Cancer. 1985 Apr 1;55(7):1563–1571. doi: 10.1002/1097-0142(19850401)55:7<1563::aid-cncr2820550726>3.0.co;2-1. [DOI] [PubMed] [Google Scholar]
  27. Wallgren A., Silfverswärd C., Eklund G. Prognostic factors in mammary carcinoma. Acta Radiol Ther Phys Biol. 1976 Feb;15(1):1–16. doi: 10.3109/02841867609132703. [DOI] [PubMed] [Google Scholar]
  28. Wilkinson G. S., Edgerton F., Wallace H. J., Jr, Reese P., Patterson J., Priore R. Delay, stage of disease and survival from breast cancer. J Chronic Dis. 1979;32(5):365–373. doi: 10.1016/0021-9681(79)90078-x. [DOI] [PubMed] [Google Scholar]

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