Does a delay in the treatment of breast cancer affect survival rates? And if so, is it the woman's delay in reporting, or the practitioner's delay in treating, that's the most important factor?
Three conflicting studies in The Lancet add to the growing literature but still do not answer the question.
A retrospective analysis of 36,222 patients with breast cancer in Yorkshire examining the effect of delays on survival rates concluded that delays of three months or more do not seem to be associated with decreased survival rates.
In fact, in this study, those who were treated most promptly had the worst outcomes.
According to the authors, more younger women under the age of 50 delay presentation by more than 90 days, when compared to those over 50 (8 per cent compared to 3 per cent).
The results suggest that the drive in the UK for all women with possible breast cancer to be seen within 14 days is a waste of resources (1999; 353: 1132-35).
This view is contrasted with two reviews by MA Richards and associates. The first (Lancet, 1999; 353: 1119-26) looked at symptoms and survival and concluded that delays of three to six months meant a 7 to 12 per cent lower five year survival rate than those with shorter delays. However, as the researchers point out, delay in reporting may mean that the disease is at a more advanced state when it is finally diagnosed.
As if to further muddy the waters, the second review (1999; 353: 1127-31) looked at who is responsible for delay. Among 23 studies, this team of researchers found that older women tended to delay going to the doctor with breast symptoms.
In contrast, younger women reporting breast symptoms other than a lump tended to meet with delays from their practitioners in being referred for proper assessment.
As the accompanying editorial suggests, rather than clarifying the issue, these analyses only add to the "delays, dilemmas and delusions" surrounding breast cancer diagnosis (1999; 353: 1112-3).