Study: Diagnosis and treatment delays in young women with breast cancer

IN-DEPTH REVIEW OF RESEARCH

Study background:

Delays in diagnosis and treatment affect breast cancer outcomes. For young women who are not routinely screened for breast cancer, Identifying factors that contribute to delays may lead to improved diagnosis and treatment.

Breast cancer becomes more likely as a woman grows older. 

Researchers of this study wanted to know:

What factors are associated with delays in breast cancer diagnosis and treatment among young women?

Population(s) looked at in the study:

The Young Women’s Breast Cancer Study was a multicenter, prospective study between 2006 and 2016 that enrolled 1,302 women ages 40 or under with newly diagnosed breast cancer. Patients were enrolled from academic and community hospitals in Massachusetts, Colorado, Minnesota and Toronto, Canada.

Study design:

Women self-reported the method and timing of their cancer detection.

Outcomes were defined as:

• Self-delay:  90 days or more from the time women noticed symptoms to when they saw a health care provider.
• Care delay: 90 days or more from the time women saw a health care provider to when they were diagnosed.
• Treatment delay: 60 days or more from when women were diagnosed to when they began treatment.

Among those reporting self-detected cancers, factors associated with self-delay and care delay were self-reported. Factors associated with treatment delay were determined from participants’ medical records.

Study findings:

The median age at diagnosis for the 1,071 eligible women was 37 years (ranging from 17-40 years), with 74% reporting self-detected cancers.

• Self-delay or care delay of 90 days or more was reported by 17% and 13% of participants, respectively.
  • Women who were pregnant at the time of diagnosis or who were financially comfortable had less self-care delay.
  • Women diagnosed up to 1 year postpartum who breastfed and those with a family history of breast or ovarian cancer were more likely to have care delay.
  • Younger age was associated with care delays.
  • Treatment delay was reported by 10% of participants and was associated with being single, non-white and having stage 0 breast cancer. Women with stage III breast cancer were less likely to have treatment delay.

Limitations:

These findings were gathered from a limited number of academic and community hospitals and thus may not be applicable to other populations. Women over 40 years of age were not included in this study, so it is unclear whether these results would apply to them.

The finding that those with a family history of breast or ovarian cancer were more likely to have a delay in diagnosis is a surprising finding. The researchers offered a few explanations including whether patients with a family history develop symptoms so quickly that health care providers have them wait 1 or 2 menstrual cycles to see if their symptoms disappear.  It is also possible that patients with a first-degree relative with breast or ovarian cancer have more anxiety when they notice a symptom, which may also contribute to a delayed diagnosis. However, in this study, only 13 women with a family history reported a delay in diagnosis, so this finding may be false.

Conclusions:

In this study, most young women with breast cancer were diagnosed and began treatment in an appropriate timeframe.

When women delay having children, their chance of being diagnosed with breast cancer during pregnancy or in the few years after a pregnancy is higher. Currently in the U.S., breast cancer is estimated to affect 1 in 3,000 women who are pregnant.

In this study, women who were diagnosed while breastfeeding or up to 1-year postpartum were more likely to experience a care delay. This may be the result of changes in the breast during pregnancy and breastfeeding that mask breast cancer symptoms.

The relationships between financial status and self-delay, and being of non-white race with treatment delay emphasize the need for additional support for underserved populations. 

Share your thoughts on this XRAYS article by taking our brief survey.

Posted 8/5/19
 

Reference

Poorvu PD, Zheng Y, Sella T, Rosenberg SM, Ruddy KJ, Gelber SI, Tamimi RM, Peppercorn JM, Schapira L, Borges VF, Come SE, Warner E and Partridge AH. Diagnostic and treatment delays in young women with breast cancer. Abstract # 6575. Presented at the 60th Annual Meeting of The American Society of Clinical Oncology, Saturday June 1, 2019, Chicago, IL.
 

Disclosure

FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board prior to publication to assure scientific integrity.