Abstract
ObjectivesA growing body of evidence suggests longer time between symptom onset and start of treatment affects breast cancer prognosis. To explore this association, the International Cancer Benchmarking Partnership Module 4 examined differences in breast cancer diagnostic pathways in 10 jurisdictions across Australia, Canada, Denmark, Norway, Sweden and the UK.SettingPrimary care in 10 jurisdictions.ParticipantData were collated from 3471 women aged >40 diagnosed for the first time with breast cancer and surveyed between 2013 and 2015. Data were supplemented by feedback from their primary care physicians (PCPs), cancer treatment specialists and available registry data.Primary and secondary outcome measuresPatient, primary care, diagnostic and treatment intervals.ResultsOverall, 56% of women reported symptoms to primary care, with 66% first noticing lumps or breast changes. PCPs reported 77% presented with symptoms, of whom 81% were urgently referred with suspicion of cancer (ranging from 62% to 92%; Norway and Victoria). Ranges for median patient, primary care and diagnostic intervals (days) for symptomatic patients were 3–29 (Denmark and Sweden), 0–20 (seven jurisdictions and Ontario) and 8–29 (Denmark and Wales). Ranges for median treatment and total intervals (days) for all patients were 15–39 (Norway, Victoria and Manitoba) and 4–78 days (Sweden, Victoria and Ontario). The 10% longest waits ranged between 101 and 209 days (Sweden and Ontario).ConclusionsLarge international differences in breast cancer diagnostic pathways exist, suggesting some jurisdictions develop more effective strategies to optimise pathways and reduce time intervals. Targeted awareness interventions could also facilitate more timely diagnosis of breast cancer.
Funder
Public Health Agency Northern Ireland
Cancer Council Victoria
Cancer Care Ontario
Partenariat Canadien Contre Le Cancer
CancerCare Manitoba Foundation
National Health Service (NHS) England
University Of Edinburgh
National Cancer Action Team
Kræftens Bekæmpelse
Research Centre for Cancer Diagnosis in Primary Care
Cancer Research UK
Helsedirektoratet
Cancer Research Wales
European Palliative Care Research Centre
Sveriges Kommuner och Landsting
Scottish Government
Sundhedsstyrelsen
Aarhus Universitet
Llywodraeth Cymru
Victorian Department of Health and Human Services
Macmillan Cancer Support
Guidelines Audit and Implementation Network
University College London
Norges Teknisk-Naturvitenskapelige Universitet
UCLH Biomedical Research Centre