Mexican Study Links Health System Delays and Later Stage Of Breast Cancer Diagnosis Interview with:
Dr. Karla Unger-Saldaña
Unit of Epidemiology
Instituto Nacional de Cancerología
Mexico City, Mexico.

Medical Research: What is the background for this study?

Dr. Unger-Saldaña: Even though Breast Cancer is most common in the developed world, most cancer deaths actually occur in developing regions. This is mainly because patients are diagnosed in advanced stages, with poor chances of survival. Most studies have shown that long times between symptom discovery and treatment start (total delay) are associated with advanced clinical stage. Like total delay, patient delay -a prolonged time between symptom discovery and the first medical consultation- has also shown to be associated with advanced clinical stage. But the impact of health system delay -the time between the first clinical consultation and the start of cancer treatment- is less clear. Studies have shown contradictory findings. For example, studies in developed countries have found the reverse association: advanced stages associated with short times between first medical consultation and treatment start. This has been attributed to the ability of doctors to quickly identify patients with advanced cancer and somehow accelerate their care.

Medical Research: What are the main findings?

Dr. Unger-Saldaña: In this study, done among 886 patients, we found that the majority started cancer treatment in advanced stages, with only 15% being diagnosed in stages 0 and I. Also, we found long delays for breast cancer diagnosis and treatment in most cases. The median time between symptom discovery and cancer treatment start was 7 months. The longest subinterval was that between the first medical consultation and diagnosis confirmation, which had a median of 4 months. The most relevant result was that not only was patient delay associated with advanced stage, but also health system delay. For every additional month of health system delay, the probability of starting treatment in advanced stage was increased by 1%.

Medical Research: What should clinicians and patients take away from your report?

Dr. Unger-Saldaña: The most relevant take home message for clinicians is that time to diagnosis, referral and cancer treatment does matter. So, we need to have audacious clinicians suspecting the diagnosis in time and acting appropriately.

For patients, our study also showed that patient delay increases the probability of starting cancer treatment in advanced stages. So it is very important that they consult a doctor as promptly as they can after discovering symptoms that could be due to breast cancer.

The biggest challenge is at the health system level, where better defined referral routes from first level health care facilities to cancer hospitals could shorten dramatically these delays.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Unger-Saldaña: There is a need of research aimed at identifying specific access barriers to medical services. This could guide health policy to improve access and reduce delays to cancer diagnosis and treatment.


Health system delay and its effect on clinical stage of breast cancer: Multicenter study

Unger-Saldaña K1, Miranda A, Zarco-Espinosa G, Mainero-Ratchelous F, Bargalló-Rocha E, Miguel Lázaro-León J.

Cancer. 2015 Mar 24. doi: 10.1002/cncr.29331. [Epub ahead of print]

[wysija_form id=”2″] Interview with: Dr. Karla Unger-Saldaña (2015). Mexican Study Links Health System Delays and Later Stage Of Breast Cancer Diagnosis 

Last Updated on April 6, 2015 by Marie Benz MD FAAD