Does delay in diagnosis of breast cancer impact prognosis?
Anne D. Walling
Background: Any delay in the diagnosis of breast cancer may be distressing to patients, family members, and physicians. The actual implications of a delayed diagnosis are not well understood. Hardin and colleagues examined the records of women who experienced delayed diagnoses and focused on physician-attributable delays, excluding delays caused by patient or health care factors.
The Study: They identified 40 patients diagnosed with invasive breast cancer between 1995 and 2005 after physician-attributable delays of three months or more. Data collected on each patient included tumor diameter, pathologic stage, number of positive axillary nodes, and death from breast cancer. Tumors are believed to grow exponentially, so the natural log of tumor diameter was calculated in each case and correlated with the delay in diagnosis.
Results: The mean delay was 14.2 months with a range of three to 36 months. The most common reason for delay in diagnosis was failure to biopsy a palpable mass when mammography and or ultrasonography results were negative. Pathology data were available for 39 of the women, and axillary node information was available for 38.
No significant correlations were demonstrated between the delay of diagnosis, the natural log of tumor diameter, or the number of positive axillary nodes. Diagnostic delay also did not correlate with tumor grade or metastatic stage. Six patients died of breast cancer, and death was associated with stage III or stage IV of the disease but not with the length of diagnostic delay.
Conclusion: Despite common fears that a diagnostic delay enables the progression of the disease and signifies lost opportunities for a better outcome, the authors conclude that delays in diagnosis of 36 months or less do not appear to worsen the prognosis of breast cancer or patient survival. They do stress that delays are undesirable and negatively impact patient and physician confidence. They also reference “the triad of error” components of a young woman, a self-detected breast mass, and a normal mammogram, which they describe as the patient most likely to be associated with delay in diagnosis.
Source: Hardin C, et al. The relationships among clinician delay of diagnosis of breast cancer and tumor size, nodal status, and stage. Am J Surg October 2006;192:506-8.
ANNE D. WALLING, M.D.
COPYRIGHT 2007 American Academy of Family Physicians
COPYRIGHT 2007 Gale Group