Pathways in the diagnosis and treatment of breast cancer : the significance of delay

Delay in the diagnosis and treatment of all types of cancer is now on the policy agenda. A recent government directive compels hospitals to ensure that all patients with a suspected breast cancer see a specialist within two weeks of an urgent referral from their General Practitioner. However the impact of system delay (the time taken for a women to be evaluated, diagnosed and treated once she has sought help) on the stage of disease and outcome in terms of survival is thought to be negligible. This empirical study aimed to explore the pathways that women followed in the process of diagnosis and treatment of breast cancer to determine how long each stage of the process took. To achieve this a prospective quantitative survey was undertaken that plotted the pathways of 300 women referred to three hospitals breast clinics, to determine whether differences in the organisations of services could explain any variations in the length of the process. The data was collected during observation of active clinics, and in addition interviews with health professionals and patients explored their perceptions of the process. The study found that there were differences in the way that services for patients with symptomatic breast problems were organised at each of the research sites. Variations were also found in the length of time taken for each stage of the process of diagnosis and treatment both within and between the sites. The variations in the time taken for the process appeared to reflect the differences in the way in which the sites were organised. Although the study did not explore the clinical outcome of delay, it was found to be important because of the anxiety experienced by women waiting for appointments and results. Minimising delay would reduce the length of time women suffer the anxiety of uncertainty.