Delay in breast cancer: implications for stage at diagnosis and survival.
Delay in breast cancer: implications for stage at diagnosis and survival.
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DOI：
10.3389/fpubh.2014.00087
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发表时间：
2014
影响因子：
5.2
通讯作者：
Caplan L
中科院分区：
文献类型：
--
作者：
Caplan L
乳腺癌仍然是一种具有巨大公共卫生意义的疾病。乳腺癌的初级预防仍然不可用，因此促进早期发现的努力仍然是与乳腺癌作斗争的主要重点。由于早期发现与降低死亡率有关，人们会认为最大限度地减少检测和诊断的延迟是很重要的。有两种主要类型的延迟。患者延迟是指在自我发现潜在的乳腺癌症状后延迟就医。系统延迟是指卫生保健系统在预约、安排诊断测试、接受确诊诊断和启动治疗方面的延迟。早期关于延迟对预后的影响的研究倾向于表明，延迟时间的增加与确诊时更晚期的癌症有关，因此导致更差的生存机会。最近的研究结果喜忧参半，一些研究表明，随着延迟时间的延长，存活率增加。一种假设是，诊断困难或许可以解释这种生存悖论。对于医生和患者来说，快速增长的肿块可能意味着癌症，而缓慢增长的肿块或其他症状对他们来说可能不那么明显。如果是这种情况，那么更具侵袭性的肿瘤延迟时间会更短，预后更差，导致存活率降低。诊断更先进的肿瘤会导致较短的生存期，这似乎是合乎逻辑的，但这篇综述中的几项反直觉的研究表明，做出假设是危险的。
Breast cancer continues to be a disease with tremendous public health significance. Primary prevention of breast cancer is still not available, so efforts to promote early detection continue to be the major focus in fighting breast cancer. Since early detection is associated with decreased mortality, one would think that it is important to minimize delays in detection and diagnosis. There are two major types of delay. Patient delay is delay in seeking medical attention after self-discovering a potential breast cancer symptom. System delay is delay within the health care system in getting appointments, scheduling diagnostic tests, receiving a definitive diagnosis, and initiating therapy. Earlier studies of the consequences of delay on prognosis tended to show that increased delay is associated with more advanced stage cancers at diagnosis, thus resulting in poorer chances for survival. More recent studies have had mixed results, with some studies showing increased survival with longer delays. One hypothesis is that diagnostic difficulties could perhaps account for this survival paradox. A rapidly growing lump may suggest cancer to both doctors and patients, while a slow growing lump or other symptoms could be less obvious to them. If this is the case, then the shorter delays would be seen with the more aggressive tumors for which the prognosis is worse leading to reduced survival. It seems logical that a tumor that is more advanced at diagnosis would lead to shorter survival but the several counter-intuitive studies in this review show that it is dangerous to make assumptions.