The Effect of Age on Delay in Diagnosis and Stage of Breast Cancer

Background. Young women with breast cancer are more likely to present with more advanced disease and are more likely to die as a result of breast cancer than their older counterparts. We sought to examine the relationship among young age (≤40 years), the likelihood of a delay in diagnosis, and stage. Methods. We examined data from women with newly diagnosed stage I–IV breast cancer presenting to one of eight National Comprehensive Cancer Network centers in January 2000 to December 2007. Delay in diagnosis was defined as time from initial sign or symptom to breast cancer diagnosis >60 days. Results. Among 21,818 women with breast cancer eligible for analysis, 2,445 were aged ≤40 years at diagnosis. Young women were not more likely to have a delay in diagnosis >60 days (odds ratio [OR], 1.08; 95% confidence interval [CI], 0.98–1.19) after adjustment for type of initial sign or symptom. Young women were only modestly more likely to present with higher stage disease after a similar adjustment (OR, 1.18; 95% CI, 1.07–1.31). Women presenting with symptomatic disease, more common in younger women, were more likely to have a delay in diagnosis (OR, 3.31; 95% CI, 3.08–3.56) and higher stage (OR, 4.31; 95% CI 4.05–4.58). Conclusion. Young age is not an independent predictor of delay in diagnosis of breast cancer and only modestly is associated with higher stage disease. Presenting with symptoms of breast cancer predicts delay and higher stage at diagnosis. 摘要 背景。 年轻女性乳腺癌患者相比年长患者在确诊时发现晚期癌症的几率更高，而且，她们的乳腺癌死亡率也更高。 我们试图探讨低龄 （≤40 岁） 与诊断和分期延误之间的关系。 方法。 我们对 2000 年 1 月至 2007 年 12 月之间前往 8 所美国国家综合癌症网络指定医院就诊的新确诊 I∼IV 期乳腺癌女性进行了分析。 所采用的诊断延误标准为从开始出现体征或症状到确诊乳腺癌之间的时间 >60 天。 结果。 在 21 818 例可纳入分析的女性乳腺癌患者中，有 2 445 例确诊时的年龄 ≤40 岁。当对初始体征或症状的类型进行校正后， 年轻女性并没有更多的发生诊断延误（确诊的时间 >60 天） [比值比（ OR）为 1.08；95% 置信区间（CI） 为 0.98‐1.19]。 进行类似校正后，年轻女性比年长女性在确诊时发现更晚期癌症的几率并未高出很多 （OR, 1.18; 95% CI, 1.07–1.31）。 初始发病时有症状的女性更容易发生诊断延误 （OR, 3.31; 95% CI, 3.08– 3.56） 且分期也更晚 （OR, 4.31; 95% CI 4.05–4.58），而初始发病时有症状的女性多为年轻女性。 结论。 低龄并不是乳腺癌诊断延误的一个独立预测指标，而且与疾病分期更晚仅存在有限的关联。 但是，初始发病时存在乳腺癌症状可以预测诊断延误和分期更晚。The Oncologist 2012;17:775–782 The relationship among young age (≤40 years), the likelihood of a delay in diagnosis, and stage was examined in breast cancer patients using a National Comprehensive Cancer Network database. Young age was not an independent predictor of a delay in diagnosis and only modestly predicted higher disease stage.