The role of private care in the interval between diagnosis and treatment of breast cancer in Northern Ireland: an analysis of Registry data

OBJECTIVE: To examine the differences in the interval between diagnosis and initiation of treatment among women with breast cancer in Northern Ireland. DESIGN: A cross-sectional observational study. SETTING: All breast cancer care patients in the Northern Ireland Cancer Registry in 2006. PARTICIPANTS: All women diagnosed and treated for breast cancer in Northern Ireland in 2006. MAIN OUTCOME MEASURE: The number of days between diagnosis and initiation of treatment for breast cancer. RESULTS: The mean (median) interval between diagnosis and initiation of treatment among public patients was 19 (15) compared with 14 (12) among those whose care involved private providers. The differences between individual public providers were as marked as those between the public and private sector—the mean (median) ranging between 14 (12) and 25 (22) days. Multivariate models revealed that the differences were evident when a range of patient characteristics were controlled for including cancer stage. CONCLUSIONS: A relatively small number of women received care privately in Northern Ireland but experienced shorter intervals between diagnosis and initiation of treatment than those who received care wholly in the public system. The variation among public providers was as great as that between the public and private providers. The impact of such differences on survival and in light of waiting time targets introduced in Northern Ireland warrants investigation.