Intended for healthcare professionals


Concealed breast cancer causes delayed treatment

BMJ 1998; 316 doi: (Published 06 June 1998) Cite this as: BMJ 1998;316:1744
  1. Rosina Ahmed, Specialist registrar,
  2. G R McLatchie, Professor of surgical science
  1. General Surgery, K Floor, Royal Hallamshire Hospital, Sheffield S10 2JF
  2. University of Sunderland, Hartlepool General Hospital, Hartlepool TS24 9AH

    EDITOR—Nosarti et al suggested that delay by patients accounts for a large part of the time till treatment for breast cancer is started.1 We agree that this delay is an important problem; it is not often analysed as policies are targeted at earlier treatment of small lesions. Iversen et al considered a delay of eight weeks by patients to be a challenge to health services.2

    We investigated the incidence of concealed breast cancer at Hartlepool General Hospital between January 1988 and December 1992 and are following up patients for five years after the initial diagnosis. We defined a breast carcinoma as a concealed cancer when the patient had been aware of a breast lump for six months or more before seeking medical advice. We retrospectively identified all patients with breast cancer through pathology records. Forty eight of the 170 patients with newly diagnosed disease had concealed carcinomas (mean (SE) time of concealment 24.3 (2.7) months). This number includes patients with other diagnoses who admitted to the lump only after it had been found by a doctor.

    The median age of patients presenting in this way was 69 years and 8 months. Seven patients were under 50. Two were lactating when they found the lump. Thirty two patients were aged over 65, indicating that the problem of concealment is larger in older women. Sixteen had fungating or ulcerated lesions at presentation. One patient died of carcinomatosis on the day after presentation; four others survived less than six months. Five patients (excluding those with carcinomatosis who were receiving palliative care) either refused all specific treatment or did not turn up for appointments for treatment.

    Breast screening began in this region in April 1990, just over half way through this study. Patients with breast cancer detected on screening were not treated at this hospital and were not included in this analysis. Although screening would not be expected to alter the course of these late tumours, the public education that accompanies the programme should increase awareness of breast disease. The proportion of patients presenting with concealed tumours before and after the initiation of screening did not differ significantly (24 out of 91 patients before screening, 24 out of 79 after screening).

    Awareness of breast carcinoma has increased with extensive media coverage, but a substantial proportion of women still do not seek early consultation. Further emphasis is needed to encourage all women with symptoms to seek appropriate advice.


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