Logo of brjcancerBJC HomepageBJC Advance online publicationBJC Current IssueSubmitting an article to BJCWeb feeds
Br J Cancer. 1998 Apr; 77(8): 1343–1348.
PMCID: PMC2150175

Who and what influences delayed presentation in breast cancer?


This study aimed to examine the extent and determinants of patient and general practitioner delay in the presentation of breast cancer. One hundred and eighty-five cancer patients attending a breast unit were interviewed 2 months after diagnosis. The main outcome measures were patient delay in presentation to the general practitioner and non-referral by the general practitioner to hospital after the patient's first visit. Nineteen per cent of patients delayed > or = 12 weeks. Patient delay was related to clinical tumour size > or = 4 cm (P = 0.0002) and with a higher incidence of locally advanced and metastatic disease (P = 0.01). A number of factors predicted patient delay: initial breast symptom(s) that did not include a lump (OR 4.5, P = 0.003), not disclosing discovery of the breast symptom immediately to someone else (OR 6.0, P < 0.001), seeking help only after being prompted by others (OR 4.4, P = 0.007) and presenting to the general practitioner with a non-breast problem (OR 3.5, P = 0.03). Eighty-three per cent of patients were referred to hospital directly after their first general practitioner visit. Presenting to the GP with a breast symptom that did not include a lump independently predicted general practitioner delay (OR 3.6, P = 0.002). In view of the increasing evidence that delay adversely affects survival, a large multicentre study is now warranted to confirm these findings that may have implications for public and medical education.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1016K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Adam SA, Horner JK, Vessey MP. Delay in treatment for breast cancer. Community Med. 1980 Aug;2(3):195–201. [PubMed]
  • Afzelius P, Zedeler K, Sommer H, Mouridsen HT, Blichert-Toft M. Patient's and doctor's delay in primary breast cancer. Prognostic implications. Acta Oncol. 1994;33(4):345–351. [PubMed]
  • Cameron A, Hinton J. Delay in seeking treatment for mammary tumors. Cancer. 1968 Jun;21(6):1121–1126. [PubMed]
  • Cameron L, Leventhal EA, Leventhal H. Symptom representations and affect as determinants of care seeking in a community-dwelling, adult sample population. Health Psychol. 1993 May;12(3):171–179. [PubMed]
  • Coates RJ, Bransfield DD, Wesley M, Hankey B, Eley JW, Greenberg RS, Flanders D, Hunter CP, Edwards BK, Forman M, et al. Differences between black and white women with breast cancer in time from symptom recognition to medical consultation. Black/White Cancer Survival Study Group. J Natl Cancer Inst. 1992 Jun 17;84(12):938–950. [PubMed]
  • Elwood JM, Moorehead WP. Delay in diagnosis and long-term survival in breast cancer. Br Med J. 1980 May 31;280(6227):1291–1294. [PMC free article] [PubMed]
  • Facione NC. Delay versus help seeking for breast cancer symptoms: a critical review of the literature on patient and provider delay. Soc Sci Med. 1993 Jun;36(12):1521–1534. [PubMed]
  • Fisher ER, Redmond C, Fisher B. A perspective concerning the relation of duration of symptoms to treatment failure in patients with breast cancer. Cancer. 1977 Dec;40(6):3160–3167. [PubMed]
  • Gould-Martin K, Paganini-Hill A, Casagrande C, Mack T, Ross RK. Behavioral and biological determinants of surgical stage of breast cancer. Prev Med. 1982 Jul;11(4):429–440. [PubMed]
  • Greer S. Psychological aspects: delay in the treatment of breast cancer. Proc R Soc Med. 1974 Jun;67(6 Pt 1):470–473. [PMC free article] [PubMed]
  • Henderson JG. Denial and repression as factors in the delay of patients with cancer presenting themselves to the physician. Ann N Y Acad Sci. 1966 Jan 21;125(3):856–864. [PubMed]
  • Jones RV, Dudgeon TA. Time between presentation and treatment of six common cancers: a study in Devon. Br J Gen Pract. 1992 Oct;42(363):419–422. [PMC free article] [PubMed]
  • MacArthur C, Smith A. Delay in breast cancer and the nature of presenting symptoms. Lancet. 1981 Mar 14;1(8220 Pt 1):601–603. [PubMed]
  • Machiavelli M, Leone B, Romero A, Perez J, Vallejo C, Bianco A, Rodriguez R, Estevez R, Chacon R, Dansky C, et al. Relation between delay and survival in 596 patients with breast cancer. Oncology. 1989;46(2):78–82. [PubMed]
  • Magarey CJ, Todd PB, Blizard PJ. Psycho-social factors influencing delay and breast self-examination in women with symptoms of breast cancer. Soc Sci Med. 1977 Mar;11(4):229–232. [PubMed]
  • Mor V, Masterson-Allen S, Goldberg R, Guadagnoli E, Wool MS. Pre-diagnostic symptom recognition and help seeking among cancer patients. J Community Health. 1990 Aug;15(4):253–266. [PubMed]
  • Neave LM, Mason BH, Kay RG. Does delay in diagnosis of breast cancer affect survival? Breast Cancer Res Treat. 1990 Feb;15(2):103–108. [PubMed]
  • Nichols S, Waters WE, Fraser JD, Wheeller MJ, Ingham SK. Delay in the presentation of breast symptoms for consultant investigation. Community Med. 1981 Aug;3(3):217–225. [PubMed]
  • Richardson JL, Langholz B, Bernstein L, Burciaga C, Danley K, Ross RK. Stage and delay in breast cancer diagnosis by race, socioeconomic status, age and year. Br J Cancer. 1992 Jun;65(6):922–926. [PMC free article] [PubMed]
  • Robinson E, Mohilever J, Zidan J, Sapir D. Delay in diagnosis of cancer. Possible effects on the stage of disease and survival. Cancer. 1984 Oct 1;54(7):1454–1460. [PubMed]
  • Rossi S, Cinini C, Di Pietro C, Lombardi CP, Crucitti A, Bellantone R, Crucitti F. Diagnostic delay in breast cancer: correlation with disease stage and prognosis. Tumori. 1990 Dec 31;76(6):559–562. [PubMed]
  • Samet JM, Hunt WC, Lerchen ML, Goodwin JS. Delay in seeking care for cancer symptoms: a population-based study of elderly New Mexicans. J Natl Cancer Inst. 1988 May 18;80(6):432–438. [PubMed]
  • Vernon SW, Tilley BC, Neale AV, Steinfeldt L. Ethnicity, survival, and delay in seeking treatment for symptoms of breast cancer. Cancer. 1985 Apr 1;55(7):1563–1571. [PubMed]
  • Zola IK. Pathways to the doctor-from person to patient. Soc Sci Med. 1973 Sep;7(9):677–689. [PubMed]

Articles from British Journal of Cancer are provided here courtesy of Cancer Research UK


Save items

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • Cited in Books
    Cited in Books
    NCBI Bookshelf books that cite the current articles.
  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...