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Causes of Physician Delay in the Diagnosis of Breast Cancer
William H. Goodson III, MD;
Dan H. Moore II, PhD
Arch Intern Med. 2002;162:1343-1348.
Background Understanding sources of physician delay in diagnosis of breast cancer
will assist efforts to expedite diagnosis.
Objective To test whether increased reliance on screening mammography has affected
causes of physician delay in diagnosis of breast cancer.
Design Survey of delays in a case series.
Setting Practice specializing in breast diseases in a region with high use of
screening mammography.
Patients Four hundred thirty-five consecutive patients treated for 454 breast
cancers of any stage.
Intervention Customary patient care.
Main Outcome Measures Whether delay was related to how cancer was identified, patient age,
individual cancer characteristics (such as tumor type), mammography reports,
or physician expertise.
Results Twenty-one women (5%) were inappropriately reassured that a malignant
lump was benign without biopsy, 14 women (3%) had a misread mammogram, 4 women
(1%) had a misread pathologic finding, and 5 women (1%) had cancer missed
by a poorly performed fine-needle aspiration biopsy. Delay was associated
with a benign mammography report (relative risk, 10.8; 95% confidence interval,
5.1-22.8), a woman finding her own mass (relative risk, 3.3; 95% confidence
interval, 1.8-6.2), and current hormone replacement therapy (relative risk,
3.1; 95% confidence interval, 1.2-8.5).
Conclusions The leading cause of physician delay in diagnosis of breast cancer continues
to be inappropriate reassurance that a mass is benign without biopsy. Reducing
delay in diagnosis will require less willingness to rely on clinical examination
to decide that a mass is benign, less reliance on benign mammography reports
to decide not to biopsy a mass, and a requirement that fine-needle aspiration
biopsy be done by persons with demonstrated competence for the procedure.
From the Department of Surgery (Dr Goodson) and the Geraldine Brush
Cancer Research Institute (Dr Moore), California Pacific Medical Research
Institute, and the Department of Epidemiology and Biostatistics, University
of California, San Francisco (Dr Moore).
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