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Typical and atypical presenting symptoms of breast cancer and their associations with diagnostic intervals: Evidence from a national audit of cancer diagnosis

INTRODUCTION: Most symptomatic women with breast cancer have relatively short diagnostic intervals but a substantial minority experience prolonged journeys to diagnosis. Atypical presentations (with symptoms other than breast lump) may be responsible. METHODS: We examined the presenting symptoms of...

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Autores principales: Koo, Minjoung Monica, von Wagner, Christian, Abel, Gary A., McPhail, Sean, Rubin, Greg P., Lyratzopoulos, Georgios
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5482318/
https://www.ncbi.nlm.nih.gov/pubmed/28549339
http://dx.doi.org/10.1016/j.canep.2017.04.010
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author Koo, Minjoung Monica
von Wagner, Christian
Abel, Gary A.
McPhail, Sean
Rubin, Greg P.
Lyratzopoulos, Georgios
author_facet Koo, Minjoung Monica
von Wagner, Christian
Abel, Gary A.
McPhail, Sean
Rubin, Greg P.
Lyratzopoulos, Georgios
author_sort Koo, Minjoung Monica
collection PubMed
description INTRODUCTION: Most symptomatic women with breast cancer have relatively short diagnostic intervals but a substantial minority experience prolonged journeys to diagnosis. Atypical presentations (with symptoms other than breast lump) may be responsible. METHODS: We examined the presenting symptoms of breast cancer in women using data from a national audit initiative (n = 2316). Symptoms were categorised topographically. We investigated variation in the length of the patient interval (time from symptom onset to presentation) and the primary care interval (time from presentation to specialist referral) across symptom groups using descriptive analyses and quantile regression. RESULTS: A total of 56 presenting symptoms were described: breast lump was the most frequent (83%) followed by non-lump breast symptoms, (e.g. nipple abnormalities (7%) and breast pain (6%)); and non-breast symptoms (e.g. back pain (1%) and weight loss (0.3%)). Greater proportions of women with ‘non-lump only’ and ‘both lump and non-lump’ symptoms waited 90 days or longer before seeking help compared to those with ‘breast lump only’ (15% and 20% vs. 7% respectively). Quantile regression indicated that the differences in the patient interval persisted after adjusting for age and ethnicity, but there was little variation in primary care interval for the majority of women. CONCLUSIONS: About 1 in 6 women with breast cancer present with a large spectrum of symptoms other than breast lump. Women who present with non-lump breast symptoms tend to delay seeking help. Further emphasis of breast symptoms other than breast lump in symptom awareness campaigns is warranted.
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spelling pubmed-54823182017-06-29 Typical and atypical presenting symptoms of breast cancer and their associations with diagnostic intervals: Evidence from a national audit of cancer diagnosis Koo, Minjoung Monica von Wagner, Christian Abel, Gary A. McPhail, Sean Rubin, Greg P. Lyratzopoulos, Georgios Cancer Epidemiol Research Article INTRODUCTION: Most symptomatic women with breast cancer have relatively short diagnostic intervals but a substantial minority experience prolonged journeys to diagnosis. Atypical presentations (with symptoms other than breast lump) may be responsible. METHODS: We examined the presenting symptoms of breast cancer in women using data from a national audit initiative (n = 2316). Symptoms were categorised topographically. We investigated variation in the length of the patient interval (time from symptom onset to presentation) and the primary care interval (time from presentation to specialist referral) across symptom groups using descriptive analyses and quantile regression. RESULTS: A total of 56 presenting symptoms were described: breast lump was the most frequent (83%) followed by non-lump breast symptoms, (e.g. nipple abnormalities (7%) and breast pain (6%)); and non-breast symptoms (e.g. back pain (1%) and weight loss (0.3%)). Greater proportions of women with ‘non-lump only’ and ‘both lump and non-lump’ symptoms waited 90 days or longer before seeking help compared to those with ‘breast lump only’ (15% and 20% vs. 7% respectively). Quantile regression indicated that the differences in the patient interval persisted after adjusting for age and ethnicity, but there was little variation in primary care interval for the majority of women. CONCLUSIONS: About 1 in 6 women with breast cancer present with a large spectrum of symptoms other than breast lump. Women who present with non-lump breast symptoms tend to delay seeking help. Further emphasis of breast symptoms other than breast lump in symptom awareness campaigns is warranted. Elsevier 2017-06 /pmc/articles/PMC5482318/ /pubmed/28549339 http://dx.doi.org/10.1016/j.canep.2017.04.010 Text en © 2017 The Author(s) http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Research Article
Koo, Minjoung Monica
von Wagner, Christian
Abel, Gary A.
McPhail, Sean
Rubin, Greg P.
Lyratzopoulos, Georgios
Typical and atypical presenting symptoms of breast cancer and their associations with diagnostic intervals: Evidence from a national audit of cancer diagnosis
title Typical and atypical presenting symptoms of breast cancer and their associations with diagnostic intervals: Evidence from a national audit of cancer diagnosis
title_full Typical and atypical presenting symptoms of breast cancer and their associations with diagnostic intervals: Evidence from a national audit of cancer diagnosis
title_fullStr Typical and atypical presenting symptoms of breast cancer and their associations with diagnostic intervals: Evidence from a national audit of cancer diagnosis
title_full_unstemmed Typical and atypical presenting symptoms of breast cancer and their associations with diagnostic intervals: Evidence from a national audit of cancer diagnosis
title_short Typical and atypical presenting symptoms of breast cancer and their associations with diagnostic intervals: Evidence from a national audit of cancer diagnosis
title_sort typical and atypical presenting symptoms of breast cancer and their associations with diagnostic intervals: evidence from a national audit of cancer diagnosis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5482318/
https://www.ncbi.nlm.nih.gov/pubmed/28549339
http://dx.doi.org/10.1016/j.canep.2017.04.010
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