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William J. Gradishar, MD, FACP, FASCO


Are Younger Women in Canada Experiencing Diagnostic Delays in Breast Cancer?

By: Victoria Kuhr, MS
Posted: Tuesday, November 28, 2023

A pan-Canadian study observed that most women younger than age 40 who were diagnosed with breast cancer presented with palpable and painful masses. However, Katherine Fleshner, MD, of the University of Calgary, Alberta, Canada, and colleagues reported that 31.7% of surveyed patients reported experiencing a diagnostic delay, “suggesting opportunities for increased education regarding presentation of early-onset breast cancer.” These findings were presented at the 2023 American Society of Clinical Oncology (ASCO) Quality Care Symposium (Abstract 117).

The study evaluated patients in the Reducing the Burden Breast Cancer in Young Women (RUBY) cohort who were younger than age 40 when diagnosed with breast cancer. Patients responded to five online surveys about demographics, medical/family history, and diagnostic journey. All patients who completed the surveys between 2015 and 2022 were included in the analysis.

This study followed the Canadian Partnership Against Cancer screening guidelines when defining the duration of “patient delay” and “system delay.” A patient delay was more than 4 weeks from the onset of symptoms to first contact with the health-care system. A system delay was more than 3 weeks from presentation to first investigation.

A total of 1,148 patients were included in the study’s analysis. The median patient age was 37 years. Of the 1,148 patients, 89% had a symptom prompting assessment; 77.3% of patients had a palpable mass, and 27.7% had a painful mass. Overall, 364 patients (31.7%) experienced a patient delay, and the median number of weeks patients waited between the onset of their symptoms and their contact with a health-care provider was 2 weeks.

Researchers observed that many patient delays occurred because of a lack of awareness associated with their symptoms. In total, 116 patients (10.1%) experienced a system delay, and 248 patients (24.4%) thought their diagnostic assessment was not completed quickly enough.

Disclosure: Dr. Fleshner reported no conflicts of interest. For full disclosures of the other study authors, visit

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