The relationship of symptoms and psychological factors to delay in seeking medical care for breast symptoms

doi:10.1016/S0091-7435(02)00053-1

Preventive Medicine

Volume 36, Issue 3, March 2003, Pages 374-378

https://doi.org/10.1016/S0091-7435(02)00053-1 Get rights and content

Abstract

Background

The psychological processes involved in the delay between noticing breast symptoms and seeking medical care are not well understood.

Methods

We evaluated 85 women referred to a specialist breast clinic prior to their clinic appointment. We assessed the relationship between delay and the type of breast symptom, immediate emotional response to the symptom, perceived risk of breast cancer, fear of breast cancer treatment, and disclosure of the breast symptom to others.

Results

Delay was unrelated to demographic factors but was related to the type of breast symptom; women who had a breast lump waited a significantly shorter time period before visiting the doctor than those without a breast lump. Initial symptom distress on the discovery of the breast symptom was also significantly related to delay. Knowledge of a friend or family member with breast cancer, perceived risk of breast cancer and fear of breast cancer treatment, and disclosure of the symptom to a partner or other person were all unrelated to delay.

Conclusions

The results show the importance of the type of symptom and initial emotional distress in delay and highlight the importance of widening public perceptions of breast symptoms other than breast lumps in order to reduce delay times.

Introduction

Recent studies have demonstrated that a longer delay in presenting with breast symptoms is associated with a lower rate of survival from breast cancer [1], [2]. Those patients waiting longer than 3 months before seeking medical attention for their symptoms have a significantly worse prognosis than those seeking help earlier. Despite the strong association between delay and survival, a considerable number of women wait for longer than 3 months before presenting with breast symptoms. For instance, a review found that 20–30% of patients had waited over 3 months before seeking medical help [1] and similar rates have been reported in the American literature [3].

Research on patient delay has identified that the initial stage of symptom interpretation, where the patient decides whether his or her symptoms need medical attention, accounts for the majority of the delay time in patients with breast symptoms [4]. The factors involved in this symptom appraisal process as it relates to breast symptoms are currently poorly understood. A number of studies have identified that women who experience a breast lump are less likely to delay than women who experience other breast symptoms such as nipple discharge or a change in shape of the breast [5], [6], [7], with a recent review finding a breast lump to be associated with shorter patient delay [8], suggesting that a breast lump is more likely to be recognized by women as a symptom needing medical attention.

The role of initial emotional response to discovery of breast symptoms and subsequent delay has not been adequately investigated. Previous research has examined whether anxiety is related to delay but the results have been inconsistent [9], [10], [11]. This may be due to the use of generalized rather than symptom-specific anxiety measures and the fact that women in these studies were often investigated following the diagnosis of breast cancer or while awaiting treatment, when their overall anxiety is likely to be high. Based on work with other illness populations, it seems likely that specific anxiety on discovery of breast symptoms would be associated with a shorter delay period [12].

Recent work has highlighted patients’ perceived risk of breast cancer to play an important role in preventative behavior, with women who believe they are more susceptible to breast cancer being more likely to participate in screening programs [13], [14]. A family history of breast cancer and familiarity with the disease through friends and acquaintances are factors that may influence perceptions of the risk of developing breast cancer. To date, the association between perceived risk of breast cancer and delay following the discovery of breast symptoms has not been systematically investigated. Negative perceptions about breast cancer treatment have also been proposed as a factor that may play a role in delay, although the few studies that have investigated this have found inconsistent results [10], [15].

Whether others play a significant role in encouraging women to seek help for breast symptoms is also unclear. In other illnesses, such as the onset of symptoms of myocardial infarction, discussion with other people can reduce delay by clarifying the degree of threat represented by the symptoms and the need for medical attention [16]. Family and significant others may also exert influence about seeking help by offering advice or recommendations about taking action. There is some evidence to suggest that women who talk to others about their breast symptom are less likely to delay [5], [17]; however, this research has been carried out in women with diagnosed breast cancer rather than with women presenting with breast symptoms per se.

In this study we investigated the association between delay and type of breast symptom, initial emotional response to the symptom, perceived risk of breast cancer, and the role of talking to others about symptoms as well as standard demographic and clinical factors. In order to overcome previous methodological difficulties inherent in using a diagnosed breast cancer population, we assessed women without a history of breast cancer referred by their doctor to a breast clinic prior to their specialist appointment and diagnosis.

Section snippets

Participants

Eighty-five women attending the South Auckland Health Breast Clinic participated in the study. The women were consecutive patients referred by their general practitioner to the clinic for specialist evaluation of breast symptoms. To be eligible for the study, participants needed to be female, have self-discovered breast symptoms rather than those detected through screening mammography or by a health professional, and have no previous history of breast cancer. Of the eligible participants

Results

The median delay for participants between discovering the symptom and seeing their general practitioner was 14 days. Of the total sample, 40% had seen their doctor within 7 days, 52% within 14 days, 69% within 30 days, and 14% of women had waited over 90 days. Delay time was not significantly related to any of the demographic data gathered including age (r = 0.01, P = 0.96), marital status (married/de facto versus not married); t(83) = −1.31, P = 0.19), living alone or not (t(83) = −0.60, P =

Discussion

This study of women with self-discovered breast symptoms found that while 40% of women saw their doctor within 1 week, 14% waited for over 3 months before seeking medical help. We found delay to be significantly related to the type of breast symptom, with women who experienced a breast lump being less likely to delay. Initial emotional distress concerning the symptom was also an important factor in women seeking medical help sooner. As the study assessed women prior to specialist evaluation, it

Acknowledgements

We thank Anne Davis, Breast Care Nurse Specialist, for her help with the project. We also thank the patients and staff at the South Auckland Health Breast Clinic for their assistance and cooperation.

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Regular articleThe relationship of symptoms and psychological factors to delay in seeking medical care for breast symptoms

Abstract

Background

Methods

Results

Conclusions

Introduction

Section snippets

Participants

Results

Discussion

Acknowledgements

Lancet

Soc Sci Med

Prev Med

Lancet

Lancet

Soc Sci Med

Prev Med

Clin Oncol

Primary invasive breast cancer in Oslo 1980–1989incidence and delay

Acta Oncol

Delay in seeking a cancer diagnosisdelay stages and psychophysiological comparison processes

Br J Soc Psychol

Regular article
The relationship of symptoms and psychological factors to delay in seeking medical care for breast symptoms