Abstract
“Diagnostic delay,” the duration of symptoms or the symptom to diagnosis interval
(SDI), are highly complex variables that reflect the behavior of the patient and the
attending physician, tumor biology and host–tumor interactions, the functioning of
the health care system, and sociocultural norms. In addition to tumor stage, other
variables mediate the relationship between duration of symptoms and survival; clinical
and epidemiologic procedures to measure them must be improved. Largely at odds with
clinical and common wisdom, decades of research have shown that often SDI is not associated
with tumor stage and/or with survival from cancer. It would be relevant to increase
evidence in support of the notion that, for each type of tumor, there is a positive
relationship between the length of the presymptomatic and the symptomatic phases.
SDI could then be used to classify tumors according to their likelihood of being detected
early when still asymptomatic. Also, tumors could be classified according to the ratio
of the median SDI to the median survival (SDI to survival ratio, SSR), which may estimate
the relative likelihood for clinical lead-time bias. If adhering to rigorous methodologic
standards, proteomic analyses of early-stage cancers might provide new insights into
changes that occur in early phases of tumorigenesis. More real examples are needed
of uses of pathologic and genomic data to study mechanisms through which SDI influences—or
fails to influence—prognosis. The degree of correlation between proteomic patterns
and classic semiology constitutes an area of interest in itself; their respective
correlations with cancer prognosis should be assessed in properly designed epidemiologic
studies.
Keywords
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Article info
Publication history
Accepted:
June 19,
2002
Identification
Copyright
© 2003 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
