Receiving a new breast cancer (BC) diagnosis can cause significant patient anxiety, which is amplified by delays in diagnosis. There is a lack of defined time periods for delays in the workup of BC. This study aims to evaluate national variations in timing from first abnormal mammogram to first biopsy and to determine independent predictors of delay in diagnosis.
Patients and Methods
Data were derived from SEER–Medicare linked claims database from 2007 to 2013. Time intervals from abnormal mammogram, either screening or diagnostic, to biopsy were assessed. The fourth quartile for timing from first mammogram to first biopsy was utilized to define delay in diagnosis. Multivariate analyses were used to evaluate the association between clinicopathologic variables and delays in diagnosis.
We analyzed 53,758 patients with stage 0–II BC who underwent upfront surgery. Significant variations in timing of care were identified, with mean times from mammogram to biopsy, surgeon visit, and breast surgery of 23.3, 31.6, and 52.6 days, respectively. Over the study period, there was a decrease in delays from mammogram to biopsy. Non-White race, Northeast location, and earlier stage disease were found to be independent predictors of delays in the diagnosis of BC (p < 0.0001).
The study demonstrates significant variations in time to diagnostic biopsy. More efficient processes of care to address these delays should be implemented, and further studies are needed to determine whether improved efficiency decreases patient anxiety. The large variations in time to diagnosis speak to the need for consensus guidelines to establish a standard of care.
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This work was supported in part by the University of Colorado Cancer Center’s Population Health Shared Resource funded by NCI grant P30CA046934 and the Surgical Outcomes and Applied Research (SOAR) program, which is a collaboration between the University of Colorado Department of Surgery (DOS) and the Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS).
The authors have no conflicts of interest to report.
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Kovar, A., Bronsert, M., Jaiswal, K. et al. The Waiting Game: How Long Are Breast Cancer Patients Waiting for Definitive Diagnosis?. Ann Surg Oncol 27, 3641–3649 (2020). https://doi.org/10.1245/s10434-020-08484-9