Typical and atypical symptoms in women with breast cancer: Evidence of variation in diagnostic intervals from a national audit of cancer diagnosis


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Minjoung Monica Koo1,Christian von Wagner1,Gary Abel2,Sean McPhail3,Greg Rubin4,Georgios Lyratzopoulos1
1UCL,2University of Exeter,3NCRAS, Public Health England,4University of Durham

Abstract

Background

The majority of women with breast cancer have relatively short diagnostic intervals. However, a significant minority experience prolonged journeys to diagnosis. Atypical presentations (with symptoms other than breast lump) may be responsible.

Method

We examined the presenting symptoms of breast cancer in women using data from a national audit initiative (n=2,316). Symptoms were grouped by topography and subsequently associations between the four most frequent symptom groups and the lengths of patient interval and primary care interval were examined using quantile regression.

Results

A total of 56 symptoms were described including breast lump which was the most common (83%); non-lump symptoms, such as nipple abnormalities (7%) and breast pain (6%); and non-breast symptoms, such as back pain (1%) and weight loss (0.3%).

Women in the ‘lump only’ symptom group, had a median (90th centile) patient interval of 7 (80) days and primary care interval of 0 (7) days. In comparison, women in the ‘non-lump only’ or ‘both lump and non-lump’ symptom groups had 1.5 times and 2.0 times longer patient intervals, and 1.6 times and 2.5 times longer primary care intervals on average compared with women presenting with ‘lump only’. Women with ‘non-breast symptoms’ had a shorter patient interval but longer primary care interval (4 (59) days and 7 (105) days respectively). Quantile regression findings demonstrated stronger associations at the higher centiles of the distribution.

Conclusion

Over 1 in 6 women with breast cancer present with symptoms other than breast lump. There were notable variations in the length of pre-referral diagnostic intervals between symptom groups, particularly at the higher centiles of the interval distributions. Our results highlight opportunities for a shift in emphasis in symptom awareness campaigns towards breast symptoms other than breast lump among both women at risk of breast cancer and health care professionals.