63 Patient- and Provider-Related Diagnostic Delay in Pregnancy-Associated Breast Cancer: A Descriptive Systematic Review

Background

Breast cancer associated with pregnancy (PABC), although rare, is still one of the most common malignancies seen during pregnancy. PABC is associated with advanced stage at presentation, often assumed in literature to be related to diagnostic delay. Although mentioned frequently, few sources detail why or how this delay occurs. The aim of this review is to explore why delayed diagnosis of PABC may occur and how it may be influenced by patient-related or provider-related factors.

Materials and Methods

This review was written using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A search was conducted in 2 databases, PubMed and Medline, up to August 2025. Included studies had to be observational, published in the English language between 2005 and 2024, and had to assess at least 1 of the following: symptoms at diagnosis, symptom to health care contact, symptom to diagnosis, or health care contact to diagnosis. The risk of bias was assessed using Joanna Briggs Institute Critical Appraisal checklists. Variables of interest were extracted and reviewed.

Results

Fourteen articles were eligible. Using 7 studies with evaluable numeric counts, 176 out of 412 (42.7%) patients experienced a 3-month or greater diagnostic delay. Rate of delay varied among studies, ranging from 21.2% to 74% of total patients. Patient-related delays were reported for 45 out of 371 (12%) patients within 5 studies. The most frequently reported reason was patients assuming symptoms were due to pregnancy or lactation (Figure). Provider-related delays were reported for 19 out of 371 (5.1%) patients in 5 studies. Reported reasons included misdiagnosis of a benign lactational condition or “reassurance from physicians” that a diagnostic workup was not warranted. Even though patient-related delays were reported more commonly than provider-related delays overall, the ratio of patient- to provider-related reasons varied greatly between studies.

Conclusions

Diagnostic delay occurred frequently in these study patients and was multifactorial, with both patients and providers playing a role in its occurrence. Symptoms being mistaken for benign breast syndromes was an issue for both patients and their providers. Interventions to address both kinds of delays could include increasing public health awareness of this disease for pregnant and postpartum patients as well as ensuring appropriate clinical suspicion in providers caring for these patients. There was great heterogeneity in results between studies, which came from different medical settings across the globe, so comparing the different studied patient populations would be a powerful next angle. Limitations of this study include heterogeneity of types of data collected between studies, small patient numbers, and no mutual exclusion stated for delay mechanisms in patients.