Exploring delays in primary gynecologic and breast cancer diagnosis after emergency department presentation

To describe factors influencing endometrial cancer (EC), ovarian cancer (OC), cervical cancer (CC) and breast cancer (BC) diagnosis and intervals (days) to diagnosis following Emergency Department (ED) presentation.

This retrospective cohort study utilized 2015-2021 institutional data and analyzed timing of diagnosis (based on administrative codes) following ED presentation. Zero-inflated negative binomial regression predicted odds of same-encounter diagnosis and, for cases not diagnosed in ED, post-ED interval.

The study included 642 people assigned female at birth (age > 18 years) with a diagnosis of cancer who had an ED visit within 6 months preceding diagnosis. Median diagnosis intervals (interquartile range) were 25 (4,65) days for EC, 3 (0,17) for OC, 7 (1,62) for CC, and 69.5 (14,124) for BC. Multivariate regression showed OC had highest odds (OR: 9.68, CI: 4.71-19.90) of same-encounter diagnosis compared to BC, with shorter intervals relative to BC for CC (IRR: 0.62, CI: 0.58-0.65), EC (IRR: 0.58, CI: 0.56-0.60), and OC (IRR: 0.35, CI: 0.33-0.36). More comorbidities increased post-ED interval (IRR: 1.09, CI: 1.05-1.10 for 3-4; IRR: 1.15, CI: 1.10-1.20 for >4). PCP access reduced diagnosis during ED-encounter odds (OR: 0.25, CI: 0.15-0.41) and extended post-ED interval (IRR: 1.19, CI: 1.16-1.22).

Gynecologic cancers are more likely to be diagnosed during an ED encounter or within shorter interval after ED-initiated encounter compared to BC. Comorbidities, PCP access, and patient-specific factors-such as insurance and race-significantly influence ED diagnosis likelihood and post-discharge intervals.