Study reveals continued care delays among patients with young-onset breast cancer

In an analysis of data on adolescents and young adults with breast cancer, lower income and younger age were linked with delays in care. The analysis published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society, also found that women who experienced delays in cancer diagnoses tended to have later stages of disease.

Breast cancer diagnosed before the age of 40 years-which is before the recommended age of screening-often carries a poor prognosis, along with unique treatment and psychosocial challenges. Because younger women tend to not undergo screening and may face delays in response to breast cancer–related symptoms due to potential biases that they are not old enough to have cancer, investigators conducted a study to understand the impact of patient and tumor characteristics on delays in care and tie impact of delays on cancer outcomes.

In the analysis of data on 1,071 individuals enrolled in the Young Women's Breast Cancer Study, a multi-site prospective cohort of young women diagnosed with breast cancer by 40 years of age, the team identified 153 presentation delays, 120 diagnostic delays, and 228 treatment delays. Presentation delays were defined as ≥90 days from time of first patient-reported symptom(s) to presentation to a clinician, diagnostic delays were ≥90 days from first health care visit for symptom(s) to date of biopsy with a diagnosis with breast cancer, and treatment delays were considered ≥60 days between the time of diagnosis to time of first treatment.

After adjusting for influencing factors, lower annual income was associated with higher odds of presentation delay, while pregnancy at diagnosis, family history of breast cancer, and triple-negative breast cancer were associated with lower odds of presentation delay. Presentation delays were also associated with later stage disease in women with certain HER2-positive tumors. Odds of diagnostic delay were higher for younger patients and lower for those with triple-negative tumors. Those who experienced a delay in breast cancer diagnosis were more likely to have late-stage disease. Patients with more aggressive tumor types were less likely to have treatment delays.

Fortunately, delays were not associated with cancer-free or overall survival, but the authors noted that later stage at diagnosis may require more extensive surgery, radiation, or systemic therapy that can impact quality of life and other outcomes.

Our study reveals continued issues in care delay among patients with young-onset breast cancer and emphasizes a need to improve both patient and provider understanding of young-onset breast cancer risk factors and symptoms to decrease disease burden among these patients."

Kristen D. Brantley, PhD, MPH, senior author, Dana-Farber Cancer Institute