Sabrina Ngaserin, Faith Leong, Benita Kiat Tee Tan, Sim Yirong

A quantitative and qualitative study of factors influencing delayed presentation, diagnosis and treatment of breast cancer patients who present with locally-advanced or metastatic disease

Abstract Disclosures

Background: Despite this appreciable shift towards detecting more early-stage breast cancers in our population and improvement in overall survival outcomes, the proportion of patients in Singapore presenting with locally advanced and metastatic breast cancer (Stage III or IV) remains curiously stable over the years, from 28.2% in 2008 to 27.1% in 2017 (NRDO 2013-2017). Preliminary review of our SingHealth data (SGH, NCCS, SKH) from previous study suggests that 3% of our patients present with T4 disease, and that incidence as also remained stable and undiminished over time. When patients present with T4 disease (i.e. involving the chest wall or skin based on AJCC TNM staging), this often means that they would have had longstanding enlarging tumors that subsequently manifested as skin nodules, peau d’orange, ulceration, or complications. This often leaves us clinicians concerned about why these patients choose to present this late in their disease course with more advanced stage tumors and correspondingly poorer survival outcomes. We are particularly interested in disease that is ‘T4 on presentation’ since can be viewed as a valuable indicator of potential deliberate delay, avoidance, or neglect.

Methods:
We aim to review patients with 1. T4 histologically-proven, 2. Stage 3, and 3. Stage 4 breast cancer. The data we are hoping to extract includes patient characteristics (age, ethnicity, marital status, family history of cancer), cancer characteristics (histology, grade, receptor status, subtype, stage), and treatment rendered.

Aim:
The primary aim of our study is to better understand the patient, physician and systemic factors that may contribute to the diagnostic and treatment delay in T4 disease. Our secondary aim is to determine how we can intervene to improve this delay and minimize the negative effects on survival and prognosis, via the application of a modified breast CAM toolkit questionnaire.

Joint Breast Cancer Registry Singapore