Six of the Best, Breast 12

Aims: The literature on the effect of delay in diagnosis of breast cancer is contradictory which may be explained by the earlier presentation of more aggressive tumours. The aim of this study was to compare prognostic factors and outcome in patients with and without a delay in diagnosis. Methods: Patients presenting with an in-hospital delay in diagnosis of breast carcinoma of more than 3 months between August 1971 and October 2000 were matched for age and tumour type with one or two control patients without a delay. The grade of tumour and lymph node status were compared between the two groups and overall survival was compared by Kaplan–Meier life table analysis. Results: There were 90 patients with a delay in diagnosis (range: 3–66 months). These were matched with 165 patients as controls. The mean age of cases was 51 years versus 52 years in controls and the mean follow up was 91 months versus 92 months. The control patients with no delay in diagnosis had more severe disease, with more grade 3 tumours (28 per cent versus 8 per cent, P = 0.01) and a nonsignificant trend to a higher positive node status (30 per cent versus 17 per cent, P = 0.098 and worse survival (P = 0.17, log-rank test). A delay of more versus less than 6 months showed no effect on life table analysis. Conclusion: This case–control study supports the hypothesis that previous paradoxical reports of an improved prognosis in patients with a delay in diagnosis of breast cancer is due to the earlier presentation of patients with more severe disease.