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

Peter Vedsted*, David Weller, Alina Zalounina Falborg, Henry Jensen, Jatinderpal Kalsi, David H Brewster, Yulan Lin, Anna Gavin, Andriana Barisic, Eva Grunfeld, Mats Lambe, Martin Malmberg, Donna Turner, Elizabeth Harland, Breann Hawryluk, Rebecca-Jane Law, Richard D Neal, Victoria White, Rebecca Bergin, Samantha HarrisonUsha Menon, Alina Zalounina Falborg, Andriana Barisi, Anna Gavin, Anne Kari Knudsen, Breann Hawryluk, Chantelle Anandan, Conan Donnelly, David H Brewster, David Weller, Donna Turner, Elizabeth Harland, Eva Grunfeld, Evangelia Ourania Fourkala, Henry Jensen, Jackie Boylan, Jacqueline Kelly, Kerry Moore, Maria Rejmyr Davis, Martin Malmberg, Mats Lambe, Oliver Bucher, Peter Vedsted, Rebecca Bergin, Rebecca-Jane Law, Richard D Neal, Sigrun Saur Almberg, Therese Kearney, Jatinderpal Kalsi, Victoria Cairnduff, The ICBP Module 4 Working Group, The ICBP Module 4 Working Group, ICBP Module 4 Academic Reference Group

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)
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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.
Original languageEnglish
Pages (from-to)e059669
JournalBMJ Open
Volume12
Issue number12
DOIs
Publication statusPublished - 15 Dec 2022

Keywords

  • Public health
  • 1506
  • 1724
  • Breast tumours
  • Epidemiology
  • Adult oncology
  • International health services
  • PUBLIC HEALTH

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