Determining the Cancer Diagnostic Interval Using Administrative Health Care Data in a Breast Cancer Cohort

Abstract

Purpose: Population-based administrative health care data could be a valuable resource with which to study the cancer diagnostic interval. The objective of the current study was to determine the first encounter in the diagnostic interval and compute that interval in a cohort of patients with breast cancer using an empirical approach.

Methods: This is a retrospective cohort study of patients with breast cancer diagnosed in Ontario, Canada, between 2007 and 2015. We used cancer registry, physician claims, hospital discharge, and emergency department visit data to identify and categorize cancer-related encounters that were more common in the three months before diagnosis. We used statistical control charts to define lookback periods for each encounter category. We identified the earliest cancer-related encounter that marked the start of the diagnostic interval. The end of the interval was the cancer diagnosis date.

Results: The final cohort included 69,717 patients with breast cancer. We identified an initial encounter in 97.8% of patients. Median diagnostic interval was 36 days (interquartile range [IQR], 19 to 71 days). Median interval decreased with increasing stage at diagnosis and varied across initial encounter categories, from 9 days (IQR, 1 to 35 days) for encounters with other cancer as the diagnosis to 231 days (IQR 77 to 311 days) for encounters with cyst aspiration or drainage as the procedure.

Conclusion: Diagnostic interval research can inform early detection guidelines and assess the success of diagnostic assessment programs. Use of administrative data for this purpose is a powerful tool for improving diagnostic processes at the population level.

FIG 1.

Steps to identifying the initial cancer-related health care encounter.

FIG 2.

Control charts for four encounter categories: (A) Breast cancer, (B) lymph system–related conditions, (C) mastectomy, and (D) Ontario Breast Screening Program (OBSP) abnormal screening mammogram. Blue lines plot weekly encounter count in 1 year before diagnosis. Red dashed lines plot the background period confidence limits.