Delays in diagnosis can predict severity.(Abstract)

2002 JUN 27 - (NewsRx.com & NewsRx.net) -- In women with asymptomatic breast cancer, delays to diagnosis greater than 20 weeks are a prognostic factor in disease severity. Findings in a recent study published in the journal Cancer indicate that a delay over 20 weeks in diagnosing asymptomatic breast cancer is associated with increasing tumor size and increasing risk of lymph node metastases.

Whether a delay of less than 20 weeks is a prognostic factor is unclear because of suspicion bias. This is a physician bias that led to women with highly suspicious, worse prognosis screens being diagnosed sooner than women with low-suspicion abnormal screens. Women with highly suspicious screens are associated with earlier diagnosis, increased tumor size and lymph node involvement.

Screening tests for breast cancer are useful because they can detect disease in women without symptoms. However, screening tests also can yield information that neither rules in nor rules out disease for the physician, leading to unnecessary and sometimes uncomfortable procedures in some women and long delays in diagnosis for others. In Canada, practice recommendations suggest prompt additional workup for highly suspicious screening abnormalities and "early recall" within 6-12 months of low-risk abnormalities for repeat screening. A recent analysis of multiple studies suggested that a delay to treatment of 3 to 6 months for women with symptomatic breast carcinoma is associated with increased rates of recurrence and mortality. There are no data whether a delay to diagnosis alters prognosis for women with screen-detected, asymptomatic breast carcinoma. Olivotto et al. investigated whether delay to diagnosis is a prognostic factor of screen-detected, asymptomatic breast carcinoma.

In this retrospective study investigators analyzed data in the Canadian Breast Cancer Screening Database of 4465 women with invasive breast cancer diagnosed within 3 years of a screening abnormality between 1990 and 1998. Data was collected on the prognostic indicators of tumor size and axillary lymph node metastases, time interval between abnormal screening and pathological diagnosis of invasive breast cancer, and other information, including clinical index of suspicion, family history of breast cancer, and age at diagnosis. Data were analyzed by chi-square tests and logistic ...