Factors associated with wait times
| Characteristic | Diagnostic interval | Pretreatment interval | ||
|---|---|---|---|---|
| Adjusted β (95% CI)* | p value | Adjusted β (95% CI)* | p value | |
| O-BAS | ||||
| No | Ref. | Ref. | ||
| Yes | −2.0 (−3.6 to −0.3) | −3.9 (−4.7 to −3.2) | ||
| Screening | < 0.0001 | < 0.0001 | ||
| Symptomatic | Ref. | Ref. | ||
| OBSP-screened | −24.8 (−26.2 to −23.3) | −2.6 (−3.3 to −2.0) | ||
| Non-OBSP-screened | 4.7 (3.3 to 6.3) | −1.2 (−1.9 to −0.5) | ||
| Sociodemographic | ||||
| Age (per 10-yr increment) | −3.3 (−3.7 to −2.8) | 0.3 (0.1 to 0.5) | ||
| Sex | ||||
| Female | Ref. | Ref. | ||
| Male | −12.6 (−19.3 to −5.9) | −2.4 (−5.3 to 0.6) | ||
| Neighbourhood income quintile‡ | 0.97 | 0.004 | ||
| Highest | Ref. | Ref. | ||
| Mid-high | −0.4 (−2.2 to 1.4) | 0.3 (−0.5 to 1.1) | ||
| Middle | −0.1 (−2.0 to 1.7) | 0.6 (−0.2 to 1.4) | ||
| Mid-low | 0.2 (−1.7 to 2.0) | 1.1 (0.3 to 1.9) | ||
| Lowest | 0.2 (−1.7 to 2.2) | 1.6 (0.7 to 2.4) | ||
| Neighbourhood immigrant density‡ | < 0.0001 | 0.18 | ||
| Least dense | Ref. | Ref. | ||
| Mid-dense | 3.7 (2.1 to 5.3) | 0.4 (−0.3 to 1.1) | ||
| Most dense | 6.3 (4.2 to 8.4) | 0.9 (−0.1 to 1.9) | ||
| Rurality‡ | ||||
| Urban | Ref. | Ref. | ||
| Rural | −0.1 (−2.3 to 2.1) | −1.0 (−1.9 to 0.0) | ||
| Distance to closest O-BAS (per 100-km increment)§ | 0.9 (−3.0 to 4.7) | 0.6 (−1.2 to 2.3) | ||
| Clinical | ||||
| Charlson Comorbidity Index | < 0.0001 | < 0.0001 | ||
| Missing | −7.8 (−9.1 to −6.5) | 1.0 (0.4 to 1.5) | ||
| 0 | Ref. | Ref. | ||
| 1 | 1.8 (−0.9 to 3.3) | 0.4 (−0.5 to 1.4) | ||
| 2 | −0.5 (−4.2 to 3.1) | 1.6 (−0.0 to 3.2) | ||
| ≥ 3 | −1.8 (−6.0 to 2.4) | 5.5 (3.6 to 7.4) | ||
| Previous breast cancer relative to diagnosis, yr | < 0.0001 | < 0.0001 | ||
| Never | Ref. | Ref. | ||
| ≤ 5 | 79.5 (72.4 to 86.6) | −8.2 (−11.5 to −5.0) | ||
| 5–10 | 34.9 (30.9 to 38.9) | 0.6 (−1.2 to 2.4) | ||
| ≥ 10 | 12.5 (9.8 to 15.3) | 0.5 (−0.8 to 1.7) | ||
| Cancer | ||||
| Laterality | 0.01 | 0.22 | ||
| Right | Ref. | Ref. | ||
| Left | 0.3 (−0.9 to 1.5) | −0.3 (−0.9 to 0.2) | ||
| Bilateral | −9.7 (−16.3 to −3.0) | 1.6 (−1.4 to 4.6) | ||
| Cancer stage | < 0.0001 | 0.0002 | ||
| 0 | 11.4 (1.8 to 21.0) | 7.0 (2.7 to 11.2) | ||
| 1 | Ref. | Ref. | ||
| 2 | −9.8 (−11.2 to −8.5) | 0.1 (−0.5 to 0.7) | ||
| 3 | −12.7 (−14.7 to −10.8) | −1.2 (−2.0 to −0.3) | ||
| 4 | −21.1 (−24.3 to −17.9) | 1.0 (−0.3 to 2.4) | ||
| Unknown | 8.7 (5.1 to 12.4) | 1.5 (−0.2 to 3.2) | ||
| Histology | < 0.0001 | < 0.0001 | ||
| Ductal | Ref. | Ref. | ||
| Lobular | 5.4 (3.3 to 7.5) | 4.2 (3.3 to 5.1) | ||
| Ductal and lobular | 0.9 (−2.0 to 3.7) | 4.9 (3.6 to 6.2) | ||
| Adenocarcinoma | 6.0 (2.1 to 9.9) | −0.1 (−1.8 to 1.6) | ||
| Mucinous | 7.7 (3.4 to 11.9) | −3.8 (−5.7 to −1.9) | ||
| Other | 3.8 (1.4 to 6.4) | 1.0 (−0.1 to 2.1) | ||
| Hormone receptor profile | 0.0007 | 0.004 | ||
| ER−, PR−, HER2− | Ref. | Ref. | ||
| ER−, PR−, HER2+ | 1.4 (−2.0 to 4.8) | −0.7 (−2.2 to 0.8) | ||
| ER−, PR+, HER2− | −1.8 (−10.8 to 7.1) | −1.6 (−5,7 to 2.4) | ||
| ER−, PR+, HER2+ | 2.3 (−11.6 to 16.3) | 0.6 (−5,5 to 6.6) | ||
| ER+, PR−, HER2− | 2.7 (−0.3 to 5.7) | −0.3 (−1.6 to 1.1) | ||
| ER+, PR−, HER2+ | −1.9 (−6.0 to 2.2) | 0.7 (−1.1 to 2.6) | ||
| ER+, PR+, HER2− | −0.1 (−2.3 to 2.0) | 1.3 (0.3 to 2.2) | ||
| ER+, PR+, HER+ | −1.1 (−4.1 to 1.9) | 0.6 (−0.7 to 1.9) | ||
| Missing | 3.4 (0.8 to 6.1) | 1.4 (0.2 to 2.6) | ||
| Topography | < 0.0001 | < 0.0001 | ||
| Upper-outer quadrant | Ref. | Ref. | ||
| Overlapping lesion | 1.9 (0.2 to 3.6) | 0.1 (−0.6 to 0.9) | ||
| Breast NOS | 9.3 (7.1 to 11.6) | −3.0 (−4.1 to −2.0) | ||
| Lower-outer quadrant | 1.0 (−1.1 to 3.1) | 0.2 (−0.7 to 1.2) | ||
| Upper-inner quadrant | −0.0 (−1.8 to 1.9) | −0.0 (−0.8 to 0.8) | ||
| Lower-inner quadrant | 0.4 (−2.1 to 3.0) | 0.2 (−0.7 to 1.2) | ||
| Central portion | 3.7 (1.0 to 6.4) | −1.3 (−2.5 to −0.1) | ||
| Nipple | 10.6 (6.5 to 14.7) | 1.2 (−1.6 to 2.0) | ||
| Axillary tail | 1.0 (−6.1 to 8.1) | 1.9 (−1.2 to 5.1) | ||
| Other | ||||
| Year of diagnosis | < 0.0001 | < 0.0001 | ||
| 2013 | Ref. | Ref. | ||
| 2014 | −1.6 (−3.4 to 0.3) | −1.3 (−2.2 to −0.5) | ||
| 2015 | −3.3 (−5.2 to −1.5) | −2.0 (−2.8 to −1.1) | ||
| 2016 | −4.2 (−6.0 to −2.3) | −2.2 (−3.0 to −1.4) | ||
| 2017 | −2.6 (−4.4 to −0.8) | −2.1 (−2.9 to −1.3) | ||
Note: CI = confidence interval, ER = estrogen receptor, HER2 = human epidermal growth factor receptor-2, NOS = not otherwise specified, O-BAS = OBSP-affiliated breast assessment site, OBSP = Ontario Breast Screening Program, OR = odds ratio, PR = progesterone receptor, Ref. = reference category.
↵* Diagnostic interval is the time from suspicion of breast cancer until diagnosis (overall mean 62 d, standard deviation [SD] 65.6 d; median 35 d, interquartile range [IQR] 19–82 d). Pre-treatment interval is the time from diagnosis of breast cancer until first treatment (overall mean 38 d, SD 29.5 d; median 34 d, IQR 23–47 d.
† Adjusted for O-BAS status, screening status, age, neighbourhood income quintile, neighbourhood immigrant density, rurality, distance to the closest O-BAS, Charlson Comorbidity Index, previous breast cancer, laterality, cancer stage, hormone receptor profile, topography, year of diagnosis and level of geography (Local Health Integration Network). β coefficients reflect the effect of a 1-unit change in the patient or tumour characteristic on the duration of the time interval, in days.
↵‡ Adapted from Statistics Canada Postal Code Conversion File and Postal Code Conversion File Plus (June 2017), which is based on data licensed from Canada Post Corporation. (16) We used the patient’s postal code at diagnosis.
↵§ β coefficients reflect the effect of a 100-km change in Euclidean distance to the patient’s closest O-BAS. We used the patient’s postal code at diagnosis.