For some women, the first sign of breast cancer may be a lump or a subtle change. But when more than 90 days pass before the first doctor’s visit, the odds of survival can change dramatically.
A multicenter cohort study in Spain found that breast cancer patients who delayed seeking medical care for more than 90 days following symptom onset were more than three times as likely to die within 2 years compared with those who sought care sooner.
The study included 543 symptomatic women diagnosed with histologically confirmed breast cancer between 2013 and 2015. Conducted across 10 hospitals in four Spanish regions, researchers defined patient-attributable delay (PPAD) as waiting over 90 days between symptom onset and first consultation with a healthcare provider. Among participants, 77 (14.18%) experienced such delays.
Patients with PPAD had a two-year mortality rate of 11.7%, compared with 3.2% among those who sought care within 90 days. After adjusting for clinical and sociodemographic variables, PPAD remained a significant independent predictor of mortality (odds ratio [OR] = 3.08; 95% confidence interval [CI] = 1.05–9.07).
Clinical stage at diagnosis was the strongest predictor of mortality. Patients with stage III–IV cancer had nearly seven times higher risk of death than those diagnosed at stage I–II (OR = 6.78; 95% CI = 2.51–18.3). Age also contributed to mortality risk (OR, = 1.04 per year; 95% CI = 1.01–1.07).
Living alone was the only independent predictor of delayed care. Individuals living alone had 88.2% greater odds of delay compared with those cohabiting (OR = 1.882; 95% CI = 1.033–3.42). Delayed patients were also older, with a mean age of 60.2 years compared with 56.3 years in the non-delayed group (P = .036).
"Patients living alone were nearly twice as likely to experience delays compared to those cohabiting, emerging as the only independent predictor of PPAD," wrote first author Desirée Martín-García, PhD, of the Department of Surgical Specialties, Biochemistry and Immunology, University of Málaga.
The study also examined clinical and pathological characteristics. Patients with a basal-like immunophenotype had the highest odds of two-year mortality (OR = 7.49; 95% CI = 2.68–20.9). Higher body mass index (BMI) was also associated with increased mortality (OR = 1.09 per unit increase; 95% CI = 1.01–1.17).
Despite access to care through Spain’s universal healthcare system, the findings highlight those individual factors such as age, social isolation, and health-seeking behavior—can significantly influence outcomes. Delays in seeking care may lead to later-stage diagnosis and reduced survival.
The authors acknowledged limitations, including the use of self-reported data for symptom onset, which may introduce recall bias, and the absence of psychosocial variables. However, they emphasized the need for targeted interventions aimed at vulnerable populations to improve early detection and reduce cancer-related mortality.
The study received funding from the Carlos III Health Institute and the Andalusian Health Department and was approved by the ethics committees of participating institutions.
The authors reported no conflicts of interest.
Source: ScienceDirect