Abstract P3-10-14: Breast cancer provider delay after the 2011 triple disaster in Fukushima, Japan
Authors: Ozaki A , Leppold C , Tsubokura M , Sawano T , Tsukada M , Ohira H 
Published: March 2017

Abstract
Introduction
Timely diagnosis and treatment is an indispensable part of breast cancer management. Delay of this process, also known as provider delay, can result in a deteriorated prognosis of affected patients. Although it has been suggested that disasters can impact cancer care and extend provider delay, there is little information available on long-term trends of breast cancer provider delay in post-disaster settings.
So-so district of Fukushima prefecture, Japan, experienced an earthquake, tsunami and the Fukushima Daiichi Nuclear Power Plant Accident in 2011. So-so district has areas falling within the mandatory, voluntary and non-evacuation ordered zones. Due to a long-term shortage of medical staff and closure of medical institutions post-disaster, patients with breast cancer may have experienced longer provider delay in this area.
Objectives
To compare provider delay of breast cancer patients and elucidate contributing factors to delay pre- and post-disaster, in an area severely affected by Japan's 2011 triple disaster.
Methods
We retrospectively investigated data of newly diagnosed breast cancer patients who undertook first medical consultation at the two main cancer centers in the non-evacuation ordered zone of So-so district from 2005 to 2016. Sociodemographic and clinical information was collected from medical records. The main outcome measure was median (days) from first medical consultation to start of breast cancer-specific treatment, pre- and post-disaster, using Mann-Whitney U test. Multivariate linear regression was then conducted to identify any factors which contributed to extended provider delay before and after the disaster.
Results
A total of 157 pre-disaster patients and 121 post-disaster patients were included in the study. There was no significant difference in the interval of median days of first medical consultation to start of first treatment pre- and post-disaster (40 vs. 39, p=0.82). Although diagnosis was made in a shorter interval post-disaster compared to pre-disaster (11 vs. 14, p=0.01) with significantly smaller median number of biopsies (1 vs. 1, p=0.001), this post-disaster improvement in diagnostic process was offset by deferred start of treatment after diagnosis (26 vs. 22, p=0.008). Among the pre-disaster patients, cancer detection by breast cancer screening program (p&lt;0.001), being engaged in full-time job (p&lt;0.042), and number of biopsies before diagnosis (p=0.005) contributed to longer provider delay in multivariate regression. However, consultation from other medical providers (p=0.03) was the only factor which significantly contributed to extended delay post-disaster, after controlling for multiple variables.
Conclusion
There was no significant increase in provider delay among breast cancer patients post-disaster. However, a median interval of 39 days from first medical consultation to start of treatment is much longer than other high-income countries, and shows much room for improvement in future.Introduction
Timely diagnosis and treatment is an indispensable part of breast cancer management. Delay of this process, also known as provider delay, can result in a deteriorated prognosis of affected patients. Although it has been suggested that disasters can impact cancer care and extend provider delay, there is little information available on long-term trends of breast cancer provider delay in post-disaster settings.
So-so district of Fukushima prefecture, Japan, experienced an earthquake, tsunami and the Fukushima Daiichi Nuclear Power Plant Accident in 2011. So-so district has areas falling within the mandatory, voluntary and non-evacuation ordered zones. Due to a long-term shortage of medical staff and closure of medical institutions post-disaster, patients with breast cancer may have experienced longer provider delay in this area.
Objectives
To compare provider delay of breast cancer patients and elucidate contributing factors to delay pre- and post-disaster, in an area severely affected by Japan's 2011 triple disaster.
Methods
We retrospectively investigated data of newly diagnosed breast cancer patients who undertook first medical consultation at the two main cancer centers in the non-evacuation ordered zone of So-so district from 2005 to 2016. Sociodemographic and clinical information was collected from medical records. The main outcome measure was median (days) from first medical consultation to start of breast cancer-specific treatment, pre- and post-disaster, using Mann-Whitney U test. Multivariate linear regression was then conducted to identify any factors which contributed to extended provider delay before and after the disaster.
Results
A total of 157 pre-disaster patients and 121 post-disaster patients were included in the study. There was no significant difference in the interval of median days of first medical consultation to start of first treatment pre- and post-disaster (40 vs. 39, p=0.82). Although diagnosis was made in a shorter interval post-disaster compared to pre-disaster (11 vs. 14, p=0.01) with significantly smaller median number of biopsies (1 vs. 1, p=0.001), this post-disaster improvement in diagnostic process was offset by deferred start of treatment after diagnosis (26 vs. 22, p=0.008). Among the pre-disaster patients, cancer detection by breast cancer screening program (p&lt;0.001), being engaged in full-time job (p&lt;0.042), and number of biopsies before diagnosis (p=0.005) contributed to longer provider delay in multivariate regression. However, consultation from other medical providers (p=0.03) was the only factor which significantly contributed to extended delay post-disaster, after controlling for multiple variables.
Conclusion
There was no significant increase in provider delay among breast cancer patients post-disaster. However, a median interval of 39 days from first medical consultation to start of treatment is much longer than other high-income countries, and shows much room for improvement in future.
Citation Format: Ozaki A, Leppold C, Tsubokura M, Sawano T, Tsukada M, Ohira H. Breast cancer provider delay after the 2011 triple disaster in Fukushima, Japan [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-10-14.