Causes of Physician Delay in the Diagnosis of Breast Cancer

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.