Diagnostic pathways for breast cancer in 10 International Cancer Benchmarking Partnership (ICBP) jurisdictions: an international comparative cohort study based on questionnaire and registry data

Abstract

Objectives: A growing body of evidence suggests longer time between symptom onset and start of treatment affects breast cancer prognosis. To explore this association, the International Cancer Benchmarking Partnership Module 4 examined differences in breast cancer diagnostic pathways in 10 jurisdictions across Australia, Canada, Denmark, Norway, Sweden and the UK.

Setting: Primary care in 10 jurisdictions.

Participant: Data were collated from 3471 women aged >40 diagnosed for the first time with breast cancer and surveyed between 2013 and 2015. Data were supplemented by feedback from their primary care physicians (PCPs), cancer treatment specialists and available registry data.

Primary and secondary outcome measures: Patient, primary care, diagnostic and treatment intervals.

Results: Overall, 56% of women reported symptoms to primary care, with 66% first noticing lumps or breast changes. PCPs reported 77% presented with symptoms, of whom 81% were urgently referred with suspicion of cancer (ranging from 62% to 92%; Norway and Victoria). Ranges for median patient, primary care and diagnostic intervals (days) for symptomatic patients were 3-29 (Denmark and Sweden), 0-20 (seven jurisdictions and Ontario) and 8-29 (Denmark and Wales). Ranges for median treatment and total intervals (days) for all patients were 15-39 (Norway, Victoria and Manitoba) and 4-78 days (Sweden, Victoria and Ontario). The 10% longest waits ranged between 101 and 209 days (Sweden and Ontario).

Conclusions: Large international differences in breast cancer diagnostic pathways exist, suggesting some jurisdictions develop more effective strategies to optimise pathways and reduce time intervals. Targeted awareness interventions could also facilitate more timely diagnosis of breast cancer.

Keywords: Adult oncology; Breast tumours; Epidemiology; International health services; PUBLIC HEALTH.

Figure 1

Diagnostic and treatment intervals.

Figure 2

Time intervals for each jurisdiction compared with Wales (reference). Adjusted for differences in comorbidity and age. Differences in interval lengths (in days) are shown for the median, 75th and 90th percentiles compared with the reference used for the regression analyses, Wales. Wales is represented by the axis, with jurisdictions with shorter intervals shown to the left of the axis and jurisdictions with longer intervals shown to the right of the axis for each graph. Solid-fill bars indicate statistically significant differences compared with Wales. Primary care interval is not shown (see table 6).