BMJ Open (Dec 2022)
Diagnostic pathways for breast cancer in 10 International Cancer Benchmarking Partnership (ICBP) jurisdictions: an international comparative cohort study based on questionnaire and registry data
- ,
- David Weller,
- Usha Menon,
- Alina Zalounina Falborg,
- Henry Jensen,
- Andriana Barisic,
- Anne Kari Knudsen,
- David H Brewster,
- Victoria Cairnduff,
- Eva Grunfeld,
- Elizabeth Harland,
- Mats Lambe,
- Rebecca-Jane Law,
- Yulan Lin,
- Martin Malmberg,
- Donna Turner,
- Richard D Neal,
- Victoria White,
- Samantha Harrison,
- Peter Vedsted,
- Una MacLeod,
- Conan Donnelly,
- Anna Gavin,
- Jon Emery,
- Oliver Bucher,
- Jatinderpal Kalsi,
- Chantelle Anandan,
- Evangelia Ourania Fourkala,
- Therese Kearney,
- Marie-Louise Essink-Bot,
- Sigrun Saur Almberg,
- Breann Hawryluk,
- Jacqueline Kelly,
- Jackie Boylan,
- Jan Willem Coebergh,
- David Brewster,
- Stefan Bergström,
- Victoria Hammersley,
- Rebecca Bergin,
- Alina Zalounina Falborg,
- Andriana Barisi,
- Kerry Moore,
- Maria Rejmyr Davis
Affiliations
- 4Global Patient Safety, BioPharmaceuticals, RandD, AstraZeneca, Gaithersburg, MD, USA
- David Weller
- professor of general practice
- Usha Menon
- 109 MRC Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, UK
- Alina Zalounina Falborg
- Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
- Henry Jensen
- 2 Research Unit for General Practice, Aarhus University, Aarhus, Denmark
- Andriana Barisic
- 4 Department of Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada
- Anne Kari Knudsen
- 14 European Palliative Care Research Centre (PRC), Olso University Hospital, Oslo, Norway
- David H Brewster
- director
- Victoria Cairnduff
- 12 Northern Ireland Cancer Registry, Queen’s University Belfast, Belfast, UK
- Eva Grunfeld
- 13 Health Services Research Program, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Elizabeth Harland
- 11 Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Rebecca-Jane Law
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
- Yulan Lin
- 14 European Palliative Care Research Centre (PRC), Olso University Hospital, Oslo, Norway
- Martin Malmberg
- 19 Department of Oncology, Lund University Hospital, Lund, Sweden
- Donna Turner
- Population Oncology, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
- Richard D Neal
- College of Medicine and Health, University of Exeter, Exeter, UK
- Victoria White
- School of Psychology, Faculty of Health, Deakin University, Burwood, Victoria, Australia
- Samantha Harrison
- 17 International Cancer Benchmarking Partnership (ICBP), Policy & Information, Cancer Research UK, London, UK
- Peter Vedsted
- professor
- Una MacLeod
- Hull York Medical School, University of Hull, Hull, UK
- Conan Donnelly
- 1 University of Cork, National Cancer Registry Ireland, Cork, Ireland
- Anna Gavin
- Northern Ireland Cancer Registry, Queen`s University Belfast, Belfast, UK
- Jon Emery
- Centre for Cancer Research, Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
- Oliver Bucher
- 5 CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Jatinderpal Kalsi
- 1 Institute for Women’s Health, University College London, London, UK
- Chantelle Anandan
- 1Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
- Evangelia Ourania Fourkala
- 3Gynaecological Cancer Research Centre, Women`s Cancer, Institute for Women`s Health, University College London, London, UK
- Therese Kearney
- 4Northern Ireland Cancer Registry, Queens University Belfast, Royal Victoria Hospital, Belfast, UK
- Marie-Louise Essink-Bot
- 1Department of Public Health, Academic Medical Center, Amsterdam, The Netherlands
- Sigrun Saur Almberg
- 3Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Breann Hawryluk
- Patient Navigation, CancerCare Manitoba, Winnipeg, Manitoba, Canada
- Jacqueline Kelly
- 2Emergency Department, North Manchester General Hospital, Manchester, UK
- Jackie Boylan
- 1Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen`s University Belfast, Belfast, Northern Ireland
- Jan Willem Coebergh
- Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven, the Netherlands.
- David Brewster
- clinical dean
- Stefan Bergström
- 6Department of Oncology, Gävle Hospital, Gävle, Sweden
- Victoria Hammersley
- research assistant
- Rebecca Bergin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
- Alina Zalounina Falborg
- Andriana Barisi
- Kerry Moore
- Maria Rejmyr Davis
- DOI
- https://doi.org/10.1136/bmjopen-2021-059669
- Journal volume & issue
-
Vol. 12,
no. 12
Abstract
Objectives A growing body of evidence suggests longer time between symptom onset and start of treatment affects breast cancer prognosis. To explore this association, the International Cancer Benchmarking Partnership Module 4 examined differences in breast cancer diagnostic pathways in 10 jurisdictions across Australia, Canada, Denmark, Norway, Sweden and the UK.Setting Primary care in 10 jurisdictions.Participant Data were collated from 3471 women aged >40 diagnosed for the first time with breast cancer and surveyed between 2013 and 2015. Data were supplemented by feedback from their primary care physicians (PCPs), cancer treatment specialists and available registry data.Primary and secondary outcome measures Patient, primary care, diagnostic and treatment intervals.Results Overall, 56% of women reported symptoms to primary care, with 66% first noticing lumps or breast changes. PCPs reported 77% presented with symptoms, of whom 81% were urgently referred with suspicion of cancer (ranging from 62% to 92%; Norway and Victoria). Ranges for median patient, primary care and diagnostic intervals (days) for symptomatic patients were 3–29 (Denmark and Sweden), 0–20 (seven jurisdictions and Ontario) and 8–29 (Denmark and Wales). Ranges for median treatment and total intervals (days) for all patients were 15–39 (Norway, Victoria and Manitoba) and 4–78 days (Sweden, Victoria and Ontario). The 10% longest waits ranged between 101 and 209 days (Sweden and Ontario).Conclusions Large international differences in breast cancer diagnostic pathways exist, suggesting some jurisdictions develop more effective strategies to optimise pathways and reduce time intervals. Targeted awareness interventions could also facilitate more timely diagnosis of breast cancer.