Delay in diagnosis of cancer. Possible effects on the stage of disease and survival

Abstract

A total of 2299 new cancer patients were referred to the Northern Israel Oncology Center in 1974 and in 1980. The stage of disease, delay in diagnosis, the responsibility for the delay, and the survival of those referred in 1974 were investigated. At the time of diagnosis, 39% of the patients had localized disease, 34% had locally advanced disease, and 23% had metastatic disease. In 52% of the patients there was no delay in diagnosis. No correlation was found in the group as a whole between the stage of disease and delay in diagnosis. Only in the breast cancer group without delay in diagnosis, however, were there significantly more patients at an early stage than at an advanced stage of disease. At each stage of disease, responsibility for the delay was shared about equally between the patients and the physicians, except in advanced breast cancer, where the patients were more often responsible for the delay. The survival rate was higher in patients in whom the disease was diagnosed earlier. It was also higher at each clinical stage (Stages I and II) in patients who had no delay than in those with delay in diagnosis. The survival rate was higher in patients who were themselves responsible for the delay in diagnosis than in patients whose physicians were responsible for the delay. In 1980, less diagnoses were delayed in fewer patients than in 1974 (42% versus 65%). Responsibility for the delay in 1980 lay equally with the patients and with the physicians, but when compared to 1974, the physicians' responsibility and administrative delay were less. Campaigns for early diagnosis are advocated.