Exploring delays in primary gynecologic and breast cancer diagnosis after emergency department presentation.

[OBJECTIVE] To describe factors influencing endometrial cancer (EC), ovarian cancer (OC), cervical cancer (CC) and breast cancer (BC) diagnosis and intervals (days) to diagnosis following Emergency Department (ED) presentation.

[METHODS] This retrospective cohort study utilized 2015-2021 institutional data and analyzed timing of diagnosis (based on administrative codes) following ED presentation. Zero-inflated negative binomial regression predicted odds of same-encounter diagnosis and, for cases not diagnosed in ED, post-ED interval.

[RESULTS] The study included 642 people assigned female at birth (age > 18 years) with a diagnosis of cancer who had an ED visit within 6 months preceding diagnosis. Median diagnosis intervals (interquartile range) were 25 (4,65) days for EC, 3 (0,17) for OC, 7 (1,62) for CC, and 69.5 (14,124) for BC. Multivariate regression showed OC had highest odds (OR: 9.68, CI: 4.71-19.90) of same-encounter diagnosis compared to BC, with shorter intervals relative to BC for CC (IRR: 0.62, CI: 0.58-0.65), EC (IRR: 0.58, CI: 0.56-0.60), and OC (IRR: 0.35, CI: 0.33-0.36). More comorbidities increased post-ED interval (IRR: 1.09, CI: 1.05-1.10 for 3-4; IRR: 1.15, CI: 1.10-1.20 for >4). PCP access reduced diagnosis during ED-encounter odds (OR: 0.25, CI: 0.15-0.41) and extended post-ED interval (IRR: 1.19, CI: 1.16-1.22).

[CONCLUSION] Gynecologic cancers are more likely to be diagnosed during an ED encounter or within shorter interval after ED-initiated encounter compared to BC. Comorbidities, PCP access, and patient-specific factors-such as insurance and race-significantly influence ED diagnosis likelihood and post-discharge intervals.