Abstract P1-05-10: Referral pathways for breast cancer diagnosis and treatment in Mexico: a physicians’ survey
Authors: Vazquez-Juarez Daniela , Andrade-Moreno Raul , Garza Cynthia Villareal 
Published: March 2023

Abstract
Background: Clinical stage at diagnosis is one of the most relevant prognostic factors for breast cancer (BC). In Mexico, more than half of BC patients are diagnosed at stage III-IV due to delays in referral, diagnosis, and treatment. The median time between symptom presentation and treatment initiation is 7 months; with the longest delay occurring between the first consultation and treatment start. The cause of this delay is not well defined. Our objective is to investigate if physicians in Mexico are aware of referral pathways in their respective institutions for patients with clinical suspicion and confirmation of BC.
Methods: Physicians were asked to answer an anonymous and voluntary survey that included 20 questions aimed at collecting general sociodemographic data, their plan of action when BC is suspected or diagnosed, and the perception of delays and barriers in breast cancer care. The survey was promoted on exclusive social networks of Mexican health professionals.
Results: In total, 802 surveys were collected. Of these, 98% were physicians, with the highest proportion (50%) being gynecologists, family, and general practitioners. The average age was 41 years, and 36% reported practicing in the public sector, 35% in the private sector, and 29% in both sectors. When faced with clinical signs and symptoms suggestive of BC, 41% of physicians in the public sector would request a breast imaging study and refer to another specialist. In contrast, 39% of specialists in the private sector preferred to request a breast imaging study and reevaluate the results.
Specialties to which physicians refer patients when suspicious in public and private sectors were gynecology 41% and 29%, surgical oncology 24% and 36%, and medical oncology 17% and 19%, respectively. In the case of a confirmed BC diagnosis, physicians preferred to refer patients to oncologic surgery in 40% and 45%, medical oncology in 40% and 32%, and gynecology in 9% and 10%, respectively. Of the healthcare professionals that were surveyed, 36% in the public sector and 67% in the private sector ignored the existence of referral pathways for BC clinical suspicion and confirmation in their institution.
Regarding the time interval from the onset of symptoms to treatment initiation, 64% of the private practice physicians estimated a waiting time of &lt; 30 days. In contrast, only 22% considered this time interval in the public sector, 30% answered between 31-90 days, and 17% replied &gt; 90 days.
Most respondents from the private sector considered factors associated with the patient as the main cause for this delay. Respondents from the public sector added to this opinion that factors related to the public health services were a contributor to the delays (Table 1). Lack of knowledge about the referral pathways was significantly associated with perceiving greater delays in care (p &lt;0.001).
Conclusion: The results of this study indicate that there is no consensus among healthcare professionals in Mexico about an action plan when breast cancer is suspected or diagnosed. Although a proportion of the respondents acknowledge the presence of established referral pathways, long waiting times and delays persist between the first evaluation and the start of treatment. Associated factors include the saturation and limited resources of public health services. The development of a universal program and its promotion among all health professionals is imperative to improve BC care in Mexico.
Table 1. Factors associated of delay in the care of clinical suspicion and confirmation of BC.
Citation Format: Daniela Vazquez-Juarez, Raul Andrade-Moreno, Cynthia Villareal Garza. Referral pathways for breast cancer diagnosis and treatment in Mexico: a physicians’ survey [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-05-10.