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Some Young Women Have Delays in Breast Cancer Evaluation and Diagnosis

Those with fewer financial resources more likely to delay seeking help for a self-detected breast change

February 6, 2014

Written By Robin Warshaw, Contributing Writer
Reviewed By Evelyn Robles-Rodriguez, RN, MSN, NPC, AOCN

Young women who detect a breast change are more likely to experience a long delay in seeking medical attention if they are less financially secure, a recent study suggests.

Though most young women studied did not experience long delays, there was a trend toward higher disease stage among those with a 90-day or longer delay between their first medical visit and diagnosis.

Background and Reason for the Study

Young women are less likely than older women to be diagnosed with breast cancer, but more likely to

  • have advanced disease at diagnosis
  • have an increased risk of the cancer coming back
  • die from breast cancer

Higher stage may be due to biologic factors in young women. It could also be due to the cancer having more time to grow because of delay in diagnosis.

Little research exists on delays in diagnosing breast cancer in young women and how they might affect outcomes. The scientists who conducted this study wanted to identify

  • signs that cause young women to first seek medical evaluation
  • how often there is a delay in diagnosis
  • factors associated with delay
  • if delay and disease stage are related

Study Structure

Researchers focused on women who were diagnosed at age 40 or younger and who self-detected a problem. This meant that the woman, a family member or friend noticed a lump, nipple change or other breast change.

Factors assessed included financial comfort level, having a close blood relative with breast or ovarian cancer, race, age and disease status at diagnosis, and more.

Two types of delay after self-detection were analyzed. Self delay occurred when a woman had a delay of 90 days or more between the first sign of a breast problem and seeking medical attention for it. Care delay described a 90-day or longer delay between a first medical visit for the abnormal change and the breast cancer diagnosis.

Findings

Of the 585 young women included in the study, 470 (80 percent) had self-detected breast abnormalities.The others were detected by clinical exam, mammogram or magnetic resonance image, or symptom such as weight loss.

Among the women with self-detected breast cancer

  • median age at diagnosis was 36
  • 48 percent were financially comfortable*
  • 99 percent had health insurance
  • median time between initial sign and seeking medical attention was 14 days
    • 17 percent had self delay ≥90 days
  • median time between medical attention and diagnosis was 16.5 days
    • 12 percent had care delay ≥90 days
  • 3 percent reported both self delay and care delay

       *Women who said their household financial situation best matched this statement:  “After paying the bills, you still have enough money for special things you want.”

The researchers stated that lack of awareness about breast cancer or “low suspicion for malignancy” among young women and healthcare professionals could account for the delays. Yet, reasons for them were not collected.

Women were more likely to delay seeing a medical provider if they were less financially comfortable. The researchers suggested that co-pays and concerns about losing wages to keep a medical appointment or other care-related costs, such as parking charges and child care, might influence self delay.

Care delay was associated with a trend toward higher disease stage that could potentially affect progression and outcome. Women with a family history of breast or ovarian cancer had more care delay than women without family history. This unexpected finding needed more study, the researchers said.

They also urged more researchers to look into whether delays could be shortened by educating young women to seek quick attention for breast abnormalities and by increasing providers’ awareness of how to evaluate young women. Interventions targeting those with less financial security who are most at risk of delay would be most effective, they claimed.

What This Means for You

A change in your breast needs prompt medical evaluation. Don’t let paying for a doctor’s visit keep you from making an appointment. Contact the LBBC Helpline for suggestions on where to find help and read our Guide to Understanding Financial Concerns.

You may feel your doctor is not responding to your concerns about possible signs of disease. Try these approaches to improve communicating with your healthcare provider.

Ruddy, KJ, Gelber, S, Tamimi, RM et al. Breast Cancer Presentation and Diagnostic Delays in Young Women.Cancer. 2014; doi:10.1002/cncr.28287

This article was supported by Cooperative Agreement Number DP11-1111 from The Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.

Denver, CO  ·  September 13, 2014

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