Delay in the presentation of breast symptoms for consultant investigation

Women referred to hospital outpatients with breast symptoms were interviewed to ascertain the interval between first noticing a breast symptom and first consulting a doctor (patient delay). Later, the hospital notes of each patient were examined to determine the intervals between this first consultation and referral by a doctor (doctor delay) and between referral and outpatient attendance (hospital delay), as well as the diagnosis (benign or malignant). The study found that the largest component of delay between noticing symptoms and outpatient attendance was patient delay, with 20 per cent of the women delaying for more than 12 weeks. Analysis of this group revealed that long delays were related to both age and subsequent diagnosis, but that these two variables were not independent of each other. The findings that there were longer delays in older women and that symptoms other than lumps, which could indicate breast cancer, were associated with long delays, have implications for health education. Generally, doctors in the community distinguished between benign and malignant cases, with 86 per cent of the latter referred within a week. Most women waited 2 weeks or less for an outpatient appointment, with none of those subsequently found to have breast cancer waiting more than 4 weeks.