Delay in breast cancer: a review of the literature

Delay in seeking medical attention for breast cancer symptoms, as well as delay in the diagnosing of and delivery of effective treatments for breast cancer may result in advanced states of disease, thereby contributing to breast cancer mortality. Our knowledge of the scope and characteristics of delay in breast cancer is limited. Delay can be divided into two components, patient and system delay. Patient delay is the time it takes for a women to seek help once she has discovered a breast symptom. System delay is the time it takes for a woman to be evaluated, diagnosed, and treated once she has sought help. Most of the studies have dealt with patient delay, with few studies being performed on system delay, especially in the United States. It is evident that patient and system delays of 2-3 months apiece do occur in a small percentage of cases. However, there is not a clear picture of the factors associated with these long delays. Studies have had conflicting results and have often been difficult to compare because of inconsistent definitions of delay. This review critically examines the available literature on delay in breast cancer. Given the lack of a complete understanding regarding the factors associated with long delay, and the fact that the earlier a breast cancer is diagnosed and treated, the greater the likelihood of long-term survival, it is especially important to do further work to determine the factors associated with long delay so that interventions can be designed to minimize delay and thus permit earlier diagnoses and treatments of breast cancers.