{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T03:42:31Z","timestamp":1789184551578,"version":"build-2803163510"},"reference-count":30,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCO"],"published-print":{"date-parts":[[2003,4,15]]},"abstract":"<jats:p> Purpose: Delaying the diagnosis and initiation of treatment of cancer is likely to result in tumor progression and a worse prognosis. We examined sources and consequences of provider delay among female breast cancer patients in a population-based study in Germany. <\/jats:p><jats:p> Patients and Methods: Three hundred eighty women, who were ages 18 to 80 years and who had invasive breast cancer, were interviewed with respect to the diagnostic process. Provider delay was defined as time from first presentation to a health care provider until initiation of cancer treatment. <\/jats:p><jats:p> Results: Median provider delay was 15 days and did not substantially differ by the specialty of first consulted physician. Delays in the diagnostic work-up were mainly because of erroneous initial suspicion of a benign breast disease or because of time constraints by patients or physicians. Provider delay over 3 months was found in 11% of all breast cancer cases and was associated with patient characteristics such as higher education (odds ratio [OR] = 2.6; 95% confidence interval [CI], 1.3 to 5.4), full-time employment (OR = 2.5; 95% CI, 1.1 to 5.5), family history of breast cancer (OR = 2.8; 95% CI, 1.2 to 6.2), and presenting with a non\u2013breast symptom (OR = 4.3; 95% CI, 1.7 to 10.9). The association between duration of diagnostic work-up and stage at diagnosis was U shaped, with the highest proportions of metastasized breast cancer tumors among women with very short (&lt; 7 days) or very long (&gt; 3 months) duration. <\/jats:p><jats:p> Conclusion: Diagnostic work-up is within reasonably short time limits among most patients with breast cancer in Germany. Although the association between delay and tumor stage seems to be complex, any delay in diagnostic work-up should be kept to a minimum. <\/jats:p>","DOI":"10.1200\/jco.2003.08.071","type":"journal-article","created":{"date-parts":[[2003,4,15]],"date-time":"2003-04-15T23:15:17Z","timestamp":1050448517000},"page":"1440-1446","source":"Crossref","is-referenced-by-count":78,"title":["Provider Delay Among Patients With Breast Cancer in Germany: A Population-Based Study"],"prefix":"10.1200","volume":"21","author":[{"given":"Volker","family":"Arndt","sequence":"first","affiliation":[{"name":"From the German Centre for Research on Ageing, Department of Epidemiology, Heidelberg; University of Ulm, Department of Epidemiology, Ulm; and Saarland Cancer Registry, Saarbr\u00fccken, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Til","family":"St\u00fcrmer","sequence":"additional","affiliation":[{"name":"From the German Centre for Research on Ageing, Department of Epidemiology, Heidelberg; University of Ulm, Department of Epidemiology, Ulm; and Saarland Cancer Registry, Saarbr\u00fccken, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christa","family":"Stegmaier","sequence":"additional","affiliation":[{"name":"From the German Centre for Research on Ageing, Department of Epidemiology, Heidelberg; University of Ulm, Department of Epidemiology, Ulm; and Saarland Cancer Registry, Saarbr\u00fccken, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hartwig","family":"Ziegler","sequence":"additional","affiliation":[{"name":"From the German Centre for Research on Ageing, Department of Epidemiology, Heidelberg; University of Ulm, Department of Epidemiology, Ulm; and Saarland Cancer Registry, Saarbr\u00fccken, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annelie","family":"Becker","sequence":"additional","affiliation":[{"name":"From the German Centre for Research on Ageing, Department of Epidemiology, Heidelberg; University of Ulm, Department of Epidemiology, Ulm; and Saarland Cancer Registry, Saarbr\u00fccken, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hermann","family":"Brenner","sequence":"additional","affiliation":[{"name":"From the German Centre for Research on Ageing, Department of Epidemiology, Heidelberg; University of Ulm, Department of Epidemiology, Ulm; and Saarland Cancer Registry, Saarbr\u00fccken, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"R1","doi-asserted-by":"publisher","DOI":"10.1016\/0277-9536(93)90340-A"},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(99)02143-1"},{"key":"R3","unstructured":"Olivotto IA, Bancej C, Goel V, et al: Waiting times from abnormal breast screen to diagnosis in 7 Canadian provinces. CMAJ 165:277,2001\u2013283,"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.1046\/j.1524-4741.1999.005001042.x"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.pubmed.a024793"},{"key":"R6","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(99)00082-3"},{"key":"R7","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(99)02374-0"},{"key":"R8","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(99)02142-X"},{"key":"R9","doi-asserted-by":"publisher","DOI":"10.3109\/02841869409098427"},{"key":"R10","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a117719"},{"key":"R11","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19861015)58:8<1756::AID-CNCR2820580829>3.0.CO;2-V"},{"key":"R12","doi-asserted-by":"publisher","DOI":"10.1023\/A:1010622909643"},{"key":"R13","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.1998.224"},{"key":"R14","unstructured":"Finley ML, Francis A: Risk factors and physician delay in the diagnosis of breast cancer. Prog Clin Biol Res 130:351,1983\u2013360,"},{"key":"R15","doi-asserted-by":"crossref","unstructured":"MacArthur C, Smith A: Delay in breast cancer and the nature of presenting symptoms. Lancet 1:601,1981\u2013603,","DOI":"10.1016\/S0140-6736(81)92044-4"},{"key":"R16","doi-asserted-by":"crossref","unstructured":"Adam SA, Horner JK, Vessey MP: Delay in treatment for breast cancer. Community Med 2:195,1980\u2013201,","DOI":"10.1007\/BF02549023"},{"key":"R17","unstructured":"Bates AT, Bates T, Hastrich DJ, et al: Delay in the diagnosis of breast cancer: The effect of the introduction of fine needle aspiration cytology to a breast clinic. Eur J Surg Oncol 18:433,1992\u2013437,"},{"key":"R18","doi-asserted-by":"publisher","DOI":"10.1016\/S0895-4356(00)00351-6"},{"key":"R19","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6600209"},{"key":"R20","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800840534"},{"key":"R21","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(197712)40:6<3160::AID-CNCR2820400661>3.0.CO;2-P"},{"key":"R22","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19830401)51:7<1226::AID-CNCR2820510709>3.0.CO;2-K"},{"key":"R23","unstructured":"Gardner B: The relationship of delay in treatment to prognosis in human cancer. Prog Clin Cancer 7:123,1978\u2013133,"},{"key":"R24","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(93)90021-R"},{"key":"R28","doi-asserted-by":"crossref","unstructured":"Nichols S, Waters WE, Fraser JD, et al: Delay in the presentation of breast symptoms for consultant investigation. Community Med 3:217,1981\u2013225,","DOI":"10.1007\/BF02549119"},{"key":"R29","unstructured":"Eltahir A, Jibril JA, Squair J, et al: The accuracy of \u201cone-stop\u201d diagnosis for 1,110 patients presenting to a symptomatic breast clinic. J R Coll Surg Edinb 44:226,1999\u2013230,"},{"key":"R30","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.322.7302.1555"},{"key":"R31","unstructured":"Mansson J, Bjorkelund C, Hultborn R: Symptom pattern and diagnostic work-up of malignancy at first symptom presentation as related to level of care: A retrospective study from the primary health care centre area of Kungsbacka, Sweden. Neoplasma 46:93,1999\u201399,"},{"key":"R32","unstructured":"Burgess C, Hunter MS, Ramirez AJ: A qualitative study of delay among women reporting symptoms of breast cancer. Br J Gen Pract 51:967,2001\u2013971,"},{"key":"R33","unstructured":"Mayo NE, Scott SC, Shen N, et al: Waiting time for breast cancer surgery in Quebec. CMAJ 164:1133,2001\u20131138,"}],"container-title":["Journal of Clinical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ascopubs.org\/doi\/pdfdirect\/10.1200\/JCO.2003.08.071","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,25]],"date-time":"2022-05-25T20:36:00Z","timestamp":1653510960000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascopubs.org\/doi\/10.1200\/JCO.2003.08.071"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2003,4,15]]},"references-count":30,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2003,4,15]]}},"alternative-id":["10.1200\/JCO.2003.08.071"],"URL":"https:\/\/doi.org\/10.1200\/jco.2003.08.071","relation":{},"ISSN":["0732-183X","1527-7755"],"issn-type":[{"value":"0732-183X","type":"print"},{"value":"1527-7755","type":"electronic"}],"subject":[],"published":{"date-parts":[[2003,4,15]]}}}