Many young women with breast cancer symptoms delay care

Many young women who have breast cancer symptoms delay timely screening and care, according to research presented April 11 at the American Society of Breast Surgeons Annual Meeting in Orlando, FL.

In her talk, Katherine Fleshner, MD, from the University of Calgary found that the leading reasons for delaying care include lack of concern, reassurance from another practitioner, difficulty accessing care, and competing priorities.

“Diagnostic delay was quite common among our cohort and most commonly was related to patient delay,” Fleshner said. “And many of the reasons for patient delay had to do with patients not being aware that what they were experiencing could be related to malignancy.”

While breast cancer is less common in younger women, radiological studies have shown that incidence rates are rising. When young women experience symptoms like lumps or breast pain, they should seek timely care, Fleshner said. If women continue to delay care or undergo mammography, their breast cancers could be diagnosed at a later stage with poorer prognosis.

Katherine Fleshner, MD, from the University of Calgary, presents research exploring trends in young women with breast cancer symptoms delaying care, including for screening mammography.Katherine Fleshner, MD, from the University of Calgary, presents research exploring trends in young women with breast cancer symptoms delaying care, including for screening mammography.

Fleshner and colleagues studied the diagnostic timeline and predictors of diagnostic delay in women ages 40 and younger throughout Canada. They included data from the Reducing the Burden of Breast Cancer in Young Women (RUBY) program.

The researchers considered a patient delay to be when women who experienced breast symptoms postponed medical guidance for more than four weeks after the onset of symptoms. They also defined a medical system delay as a wait of more than three weeks for evaluation of a complaint by any physician.

The study included data collected between 2015 and 2022 from 1,148 women enrolled in the RUBY program with a median participation age of 37 years. Of the total, 36.8% had a first-degree relative with cancer and 43% were otherwise healthy.

The researchers found that 89% of the women presented with a symptom. Of the symptomatic women, 77.3% had a palpable mass. Other symptoms reported included breast pain, nipple discharge, changes in the skin and nipples, and a combination of multiple symptoms.

Additionally, the median wait time before seeking assessment was two weeks. However, about one third of patients waited for more than four weeks to seek care.

The following were reasons for delay as reported by the study participants: lack of concern (48.5%), waiting to see if the symptom would go away on its own (32.9%), reassurance from another practitioner (6.9%), difficulty accessing care (6.4%), competing priorities (3.6%), and fear (1.7%).

On multivariable analysis, a painful lump and a first-degree relative with a history of breast cancer were independent predictors of patient delay in seeking care. Of the participants with these predictors, 31.7% experienced a patient delay while 10.1% experienced a system delay once a concerning symptom was recognized by a physician.

“Most patients were received quickly within the one- to two-week period,” Fleshner said.

Fleshner suggested that better awareness on both the public and practitioner end is needed regarding what constitutes as a concerning symptom and the importance of follow-up care and imaging if symptoms persist or worsen.

“The diagnostic journey overall can be complex in this patient population, mostly because there is a large percentage of benign breast findings in young women,” she said. “Sometimes there were symptoms that led to investigations that found cancers totally unrelated to their symptoms such as on the other side of or in a different spot than where they noticed changes.”

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