Delays in breast cancer presentation, diagnosis, and treatment in young women

Abstract

BACKGROUND: Breast cancer (BC) in young patients is often identified at later stages, which can result in poor prognosis. It is important to investigate the factors influencing care delays and how delays affect outcomes. METHODS: This study included women aged ≤40 years at diagnosis of stage 0-IV BC in the Young Women's Breast Cancer Study enrolled between 2006 and 2016. Associations between patient and tumor factors and presentation delay (first symptom to provider visit, ≥90 days), diagnostic delay (presentation to diagnosis, ≥90 days), and treatment delay (diagnosis to treatment, ≥60 days) were estimated via logistic regression. Multivariable logistic models for delays were constructed via backward selection (p ≤ .05 retained). Multivariable Cox proportional hazards models tested the association between delays and disease-free survival (DFS) and overall survival (OS). Analyses were stratified by tumor subtype and stage. RESULTS: Among 1071 women, there were 153 presentation, 120 diagnostic, and 228 treatment delays. In multivariable models, lower annual income was associated with higher odds of presentation delay, whereas pregnancy at diagnosis, family history of BC, and triple-negative (TN) subtype were associated with lower odds. In HER2-positive luminal B tumors, presentation delays were associated with later stage (p < .001). Odds of diagnostic delay were higher for younger patients and lower for those with TN tumors. Patients with more aggressive tumor subtypes were less likely to have treatment delays. Delays were not associated with DFS or OS. CONCLUSIONS: In this cohort of young patients with BC, demographic and tumor factors were associated with delays in care. It is reassuring that delays did not influence disease outcomes.