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Poorer women with a breast lump may wait to see doctor

By Kathryn Doyle

NEW YORK (Reuters Health) - Poor young women are more likely to delay going to the doctor when they find a breast lump than women in better financial straits, a new study suggests.

Researchers surveyed young breast cancer patients about how they first discovered their cancer, how long they waited to see a doctor and how long after diagnosis they started treatment.

"We know that women from underserved communities have a greater risk of recurrence and death from cancer, and this is just one more reason women from this group might not do as well," Dr. Ann H. Partridge, who worked on the study, said.

She is the director of the Program for Young Women with Breast Cancer in the Susan F. Smith Center for Women's Cancer at Dana-Farber Cancer Institute in Boston.

Approximately one woman in 200 will get breast cancer before she turns 40.

Young women diagnosed with the disease tend to fare worse than older women, a phenomenon which has confounded researchers.

One explanation says young women are often diagnosed with more advanced disease because they wait longer to go to the doctor and get checked out. Based on recent studies of UK and U.S. national data, young women often experience delays in getting diagnosed.

For the new study, Partridge and her colleagues talked to almost 600 young women with breast cancer. Unsurprisingly, 80 percent of those women had found a lump themselves, compared to 12 percent whose cancer showed up on an imaging test - like a mammogram or MRI.

Mammograms are not recommended for women under 40 years old based on most U.S. guidelines.

For six percent of the women, a doctor found a lump during a physical exam. The remaining one percent felt generally ill and visited the doctor, later learning that breast cancer was the reason.

Among women who detected their own lumps, 17 percent waited more than three months to visit a doctor.

Women with fewer financial resources - who said they had little money left over after paying the bills - were more likely to delay going to the doctor.

Of those who reported being short on cash, 22 percent delayed seeing a doctor after finding a lump. That compared to 12 percent of more financially comfortable young women.

Twelve percent of women who found their own lumps also waited more than three months between first visiting the doctor and getting diagnosed with breast cancer. That wait was not related to women's financial state, according to findings published in Cancer.

A three-month delay in care could make a difference for some women, but that varies case by case, Partridge told Reuters Health.

It's encouraging that a majority of women did not experience delays between discovery of a lump and a doctor's visit or a doctor's visit and diagnosis, according to Theresa Keegan.

But the women in this study were primarily white and educated, and the results might not generalize to other groups, she said.

Keegan is a research scientist at the Cancer Prevention Institute of California in Fremont, specializing in breast cancer occurrence and survival among young women. She was not involved in the new study.

Her own research has suggested women diagnosed with breast cancer before age 40 are more likely to be non-white than older women.

"Thus, it is very important to extend this work to other racial/ethnic and socioeconomic groups," Keegan told Reuters Health in an email.

Younger women, who are less likely to be insured, might feel the financial pinch of seeing a doctor more than older women, Keegan said.

The current study did not include older women and can't answer that question. All it can say is that finances are a factor for some young women.

To address disparities on a community-wide scale, more studies are needed to assess just why these delays occur. Some women may have trouble getting childcare during a doctor's visit, some may be afraid of the outcome if they do go to the doctor and some may not be able to get time off from work, Partridge said.

"Ultimately we need to increase awareness in communities with lower resources," she said.

A woman who suspects something abnormal in her breast should get evaluated by a doctor immediately, Keegan said.

"Early detection is the most important determinant of outcome for young women with breast cancer," she said.

SOURCE: http://bit.ly/19ensut Cancer, online November 11, 2013.

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