Limits...
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

The adjusted odds ratio of screen-detected female breast cancer diagnosed in Alberta, Canada (2004–2010).1 Adjusted for all the variables shown plus the interaction terms of RHA by Time Period; 2The reference group is: age group 50–69, cancer stage 1, usual provider continuity > 0.75, Charlson comorbidity index 0 or 1, RHA 3/6, and time period 2004–2006.*RHAs that have similar estimated odds were grouped together. The reference RHAs are the metropolitan regions, 3&6
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig3: The adjusted odds ratio of screen-detected female breast cancer diagnosed in Alberta, Canada (2004–2010).1 Adjusted for all the variables shown plus the interaction terms of RHA by Time Period; 2The reference group is: age group 50–69, cancer stage 1, usual provider continuity > 0.75, Charlson comorbidity index 0 or 1, RHA 3/6, and time period 2004–2006.*RHAs that have similar estimated odds were grouped together. The reference RHAs are the metropolitan regions, 3&6

Mentions: Figure 3 shows the forest plot of the adjusted odds ratios from the multivariable logistic regression model in which the outcome is screen-detected cancer. RHAs that had similar estimated odds were grouped together. Patients outside of the screening-eligible age group were less likely to be screen-detected except for age group 70–74 (OR: 0.93, 95 % CI: 0.80–1.06). The likelihood of being screen-detected increased with decreasing disease stage. Compared to stage I cancer, the estimated odds ratio of being screen-detected was 1.57, 0.37, 0.19 and 0.12 for in situ, stages II, III, and IV cancers, respectively (P < 0.001). Having a comorbidity index greater than or equal to 2 was associated with a decreased odds of being screen-detected comparing to those with a comorbidity index less than 2 (OR: 0.73, 95 % CI: 0.65–0.88).Fig. 3


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)

The adjusted odds ratio of screen-detected female breast cancer diagnosed in Alberta, Canada (2004–2010).1 Adjusted for all the variables shown plus the interaction terms of RHA by Time Period; 2The reference group is: age group 50–69, cancer stage 1, usual provider continuity > 0.75, Charlson comorbidity index 0 or 1, RHA 3/6, and time period 2004–2006.*RHAs that have similar estimated odds were grouped together. The reference RHAs are the metropolitan regions, 3&6
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig3: The adjusted odds ratio of screen-detected female breast cancer diagnosed in Alberta, Canada (2004–2010).1 Adjusted for all the variables shown plus the interaction terms of RHA by Time Period; 2The reference group is: age group 50–69, cancer stage 1, usual provider continuity > 0.75, Charlson comorbidity index 0 or 1, RHA 3/6, and time period 2004–2006.*RHAs that have similar estimated odds were grouped together. The reference RHAs are the metropolitan regions, 3&6
Mentions: Figure 3 shows the forest plot of the adjusted odds ratios from the multivariable logistic regression model in which the outcome is screen-detected cancer. RHAs that had similar estimated odds were grouped together. Patients outside of the screening-eligible age group were less likely to be screen-detected except for age group 70–74 (OR: 0.93, 95 % CI: 0.80–1.06). The likelihood of being screen-detected increased with decreasing disease stage. Compared to stage I cancer, the estimated odds ratio of being screen-detected was 1.57, 0.37, 0.19 and 0.12 for in situ, stages II, III, and IV cancers, respectively (P < 0.001). Having a comorbidity index greater than or equal to 2 was associated with a decreased odds of being screen-detected comparing to those with a comorbidity index less than 2 (OR: 0.73, 95 % CI: 0.65–0.88).Fig. 3

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