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Provider Delay Among Patients With Breast Cancer in Germany: A Population-Based Study

Volker Arndt, Til Stürmer, Christa Stegmaier, Hartwig Ziegler, Annelie Becker, Hermann Brenner

From the German Centre for Research on Ageing, Department of Epidemiology, Heidelberg; University of Ulm, Department of Epidemiology, Ulm; and Saarland Cancer Registry, Saarbrücken, Germany.

Address reprint requests to Volker Arndt, The German Centre for Research on Ageing (DZFA), Department of Epidemiology, Bergheimer Strasse 20, D-69115 Heidelberg, Germany; email: arndt{at}dzfa.uni-heidelberg.de.

Purpose: Delaying the diagnosis and initiation of treatment of cancer is likely to result in tumor progression and a worse prognosis. We examined sources and consequences of provider delay among female breast cancer patients in a population-based study in Germany.

Patients and Methods: Three hundred eighty women, who were ages 18 to 80 years and who had invasive breast cancer, were interviewed with respect to the diagnostic process. Provider delay was defined as time from first presentation to a health care provider until initiation of cancer treatment.

Results: Median provider delay was 15 days and did not substantially differ by the specialty of first consulted physician. Delays in the diagnostic work-up were mainly because of erroneous initial suspicion of a benign breast disease or because of time constraints by patients or physicians. Provider delay over 3 months was found in 11% of all breast cancer cases and was associated with patient characteristics such as higher education (odds ratio [OR] = 2.6; 95% confidence interval [CI], 1.3 to 5.4), full-time employment (OR = 2.5; 95% CI, 1.1 to 5.5), family history of breast cancer (OR = 2.8; 95% CI, 1.2 to 6.2), and presenting with a non–breast symptom (OR = 4.3; 95% CI, 1.7 to 10.9). The association between duration of diagnostic work-up and stage at diagnosis was U shaped, with the highest proportions of metastasized breast cancer tumors among women with very short (< 7 days) or very long (> 3 months) duration.

Conclusion: Diagnostic work-up is within reasonably short time limits among most patients with breast cancer in Germany. Although the association between delay and tumor stage seems to be complex, any delay in diagnostic work-up should be kept to a minimum.

Supported by grant no. 70-1816 from the German Cancer Foundation (Deutsche Krebshilfe).

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