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Factors related to breast cancer detection mode and time to diagnosis in Alberta, Canada: a population-based retrospective cohort study.

Yuan Y, Li M, Yang J, Elliot T, Dabbs K, Dickinson JA, Fisher S, Winget M - BMC Health Serv Res (2016)

Bottom Line: Understanding the factors affecting the mode and timeliness of breast cancer diagnosis is important to optimizing patient experiences and outcomes.Screen-detected patients were identified as having a screening mammogram within 6-months prior to diagnosis; remaining patients were considered symptom-detected.The variation by health region, however, was large ranging from an estimated median of 4 to 37 days for screen-detected patients and from 17 to 33 days for symptom-detected patients.

View Article: PubMed Central - PubMed

Affiliation: School of Public Health, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada. yyuan@ualberta.ca.

ABSTRACT

Background: Understanding the factors affecting the mode and timeliness of breast cancer diagnosis is important to optimizing patient experiences and outcomes. The purposes of the study were to identify factors related to the length of the diagnostic interval and assess how they vary by mode of diagnosis: screen or symptom detection.

Methods: All female residents of Alberta diagnosed with first primary breast cancer in years 2004-2010 were identified from the Alberta Cancer Registry. Data were linked to Physician Claims and screening program databases. Screen-detected patients were identified as having a screening mammogram within 6-months prior to diagnosis; remaining patients were considered symptom-detected. Separate quantile regression was conducted for each detection mode to assess the relationship between demographic/clinical and healthcare factors.

Results: Overall, 38 % of the 12,373 breast cancer cases were screen-detected compared to 47 % of the screen-eligible population. Health region of residence was strongly associated with cancer detection mode. The median diagnostic interval for screen and symptom-detected cancers was 19 and 21 days, respectively. The variation by health region, however, was large ranging from an estimated median of 4 to 37 days for screen-detected patients and from 17 to 33 days for symptom-detected patients. Cancer stage was inversely associated with the diagnostic interval for symptom-detected cancers, but not for screen-detected cancers.

Conclusion: Significant variation by health region in both the percentage of women with screen-detected cancer and the length of the diagnostic interval for screen and symptom-detected breast cancers suggests there could be important differences in local breast cancer diagnostic care coordination.

No MeSH data available.


Related in: MedlinePlus

An illustration of the diagnostic interval for screen and symptom detected breast cancers. For the screen-detected cancers (panel a), the diagnostic interval is the time between the date of diagnosis and the date of the screening mammogram, a maximum of 6 months. For the symptom-detected cancers (panel b), the diagnostic interval is the time between the date of diagnosis and the date of the most proximal GP visit prior to the first diagnostic test, a maximum of 12 months
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Fig1: An illustration of the diagnostic interval for screen and symptom detected breast cancers. For the screen-detected cancers (panel a), the diagnostic interval is the time between the date of diagnosis and the date of the screening mammogram, a maximum of 6 months. For the symptom-detected cancers (panel b), the diagnostic interval is the time between the date of diagnosis and the date of the most proximal GP visit prior to the first diagnostic test, a maximum of 12 months

Mentions: Breast cancer was defined as screen-detected if the patient had a screening mammogram within the look-back period. The length of the diagnostic interval was defined as the time from the date of the screening mammogram to the date of breast cancer diagnosis, typically the first positive percutaneous or surgical biopsy date. The remaining cancers were defined as symptom-detected. The earliest breast cancer related diagnostic procedure in the look-back period, usually a diagnostic mammogram, was defined as the first relevant diagnostic test. The most proximal visit to a PCP within 6-months prior to the first relevant test was defined as the start of the diagnostic interval for symptom-detected patients, because in most cases a diagnostic test can only be conducted if a referral is made by a PCP. The diagnostic interval for symptom-detected patients, therefore, is defined as the time interval from the date of the PCP visit to the date of cancer diagnosis. Figure 1 summarizes the diagnostic interval by detection method as described above.Fig. 1


Factors related to breast cancer detection mode and time to diagnosis in Alberta, Canada: a population-based retrospective cohort study.

Yuan Y, Li M, Yang J, Elliot T, Dabbs K, Dickinson JA, Fisher S, Winget M - BMC Health Serv Res (2016)

An illustration of the diagnostic interval for screen and symptom detected breast cancers. For the screen-detected cancers (panel a), the diagnostic interval is the time between the date of diagnosis and the date of the screening mammogram, a maximum of 6 months. For the symptom-detected cancers (panel b), the diagnostic interval is the time between the date of diagnosis and the date of the most proximal GP visit prior to the first diagnostic test, a maximum of 12 months
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4759735&req=5

Fig1: An illustration of the diagnostic interval for screen and symptom detected breast cancers. For the screen-detected cancers (panel a), the diagnostic interval is the time between the date of diagnosis and the date of the screening mammogram, a maximum of 6 months. For the symptom-detected cancers (panel b), the diagnostic interval is the time between the date of diagnosis and the date of the most proximal GP visit prior to the first diagnostic test, a maximum of 12 months
Mentions: Breast cancer was defined as screen-detected if the patient had a screening mammogram within the look-back period. The length of the diagnostic interval was defined as the time from the date of the screening mammogram to the date of breast cancer diagnosis, typically the first positive percutaneous or surgical biopsy date. The remaining cancers were defined as symptom-detected. The earliest breast cancer related diagnostic procedure in the look-back period, usually a diagnostic mammogram, was defined as the first relevant diagnostic test. The most proximal visit to a PCP within 6-months prior to the first relevant test was defined as the start of the diagnostic interval for symptom-detected patients, because in most cases a diagnostic test can only be conducted if a referral is made by a PCP. The diagnostic interval for symptom-detected patients, therefore, is defined as the time interval from the date of the PCP visit to the date of cancer diagnosis. Figure 1 summarizes the diagnostic interval by detection method as described above.Fig. 1

Bottom Line: Understanding the factors affecting the mode and timeliness of breast cancer diagnosis is important to optimizing patient experiences and outcomes.Screen-detected patients were identified as having a screening mammogram within 6-months prior to diagnosis; remaining patients were considered symptom-detected.The variation by health region, however, was large ranging from an estimated median of 4 to 37 days for screen-detected patients and from 17 to 33 days for symptom-detected patients.

View Article: PubMed Central - PubMed

Affiliation: School of Public Health, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada. yyuan@ualberta.ca.

ABSTRACT

Background: Understanding the factors affecting the mode and timeliness of breast cancer diagnosis is important to optimizing patient experiences and outcomes. The purposes of the study were to identify factors related to the length of the diagnostic interval and assess how they vary by mode of diagnosis: screen or symptom detection.

Methods: All female residents of Alberta diagnosed with first primary breast cancer in years 2004-2010 were identified from the Alberta Cancer Registry. Data were linked to Physician Claims and screening program databases. Screen-detected patients were identified as having a screening mammogram within 6-months prior to diagnosis; remaining patients were considered symptom-detected. Separate quantile regression was conducted for each detection mode to assess the relationship between demographic/clinical and healthcare factors.

Results: Overall, 38 % of the 12,373 breast cancer cases were screen-detected compared to 47 % of the screen-eligible population. Health region of residence was strongly associated with cancer detection mode. The median diagnostic interval for screen and symptom-detected cancers was 19 and 21 days, respectively. The variation by health region, however, was large ranging from an estimated median of 4 to 37 days for screen-detected patients and from 17 to 33 days for symptom-detected patients. Cancer stage was inversely associated with the diagnostic interval for symptom-detected cancers, but not for screen-detected cancers.

Conclusion: Significant variation by health region in both the percentage of women with screen-detected cancer and the length of the diagnostic interval for screen and symptom-detected breast cancers suggests there could be important differences in local breast cancer diagnostic care coordination.

No MeSH data available.


Related in: MedlinePlus