Delay by internists in obtaining diagnostic biopsies in patients with suspected cancer

Objective: To investigate the degree and type of delays in performing diagnostic biopsies in medical patients with suspected malignancy. Design: Retrospective survey of clinical histories of patients referred between January 1985 and March 1989. Setting: Inner city teaching hospital internal medicine (nononcologic) services. Patients: Patients with gastrointestinal and lung cancers, adenocarcinoma of unknown primary site, and lymphomas were referred as inpatients by internists. Two hundred fifty-five patients were eligible, and 177 were evaluable. Main Outcome Measures: The number, type, and results of tests done before and after biopsy were analyzed. Results: In 67% of patients the biopsied lesion was detected by the second day of evaluation; however, there was an 8- to 10-day delay before a biopsy was done. This delay was consistent across the four malignancy groups studied. Although logistic and other unavoidable delays occurred in 40% of the cases, in 60% delays could only be attributed to continued, frequently low yield, noninvasive tests. An average of 3.3 tests were made per patient, with only 24% leading to a definitive biopsy. Conclusion: Because of the performance of many other tests, a substantial delay exists in proceeding to biopsy during the diagnosis of cancer by internists.