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Methods analyze firsthand experiences shared on an online discussion board by the Young Survival Coalition from 2009 to 2019, using natural language processing to detect codes for first signs, diagnostic steps, healthcare interactions, patient-provider-system feelings, and staging/type. A training dataset includes coded text from 750 of 571,914 posts, with automated quantification and qualitative review. Results show 81% self-detection and delays driven by dismissal, insensitive imaging, and missed biopsy confirmation. Conclusion emphasizes sociomedical support and research on breast awareness, MRI/ultrasound, and biopsy referrals.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/cancers-missed-women-dismissed-yet-persist-natural-language-processing-of-online-forums/367462/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/cancers-missed-women-dismissed-yet-persist-natural-language-processing-of-online-forums/367462.png","ImageObject",300,407,{"name":92,"@type":93},"Riley West","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-25","2026-09-23",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is the study’s main objective?","Question",{"text":112,"@type":113},"To identify gaps and delays in the detection of early onset cancer, focusing on how young adults experience the diagnostic pathway.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How did the researchers analyze the online forum data?",{"text":117,"@type":113},"They used natural language processing to detect specific diagnostic-related codes and applied qualitative content analysis to code text from 750 posts in a dataset drawn from 571,914 total posts.",{"name":119,"@type":110,"acceptedAnswer":120},"What delays did young adults report, and what effect did they have?",{"text":121,"@type":113},"Young adults described dissatisfaction with care due to delays at decision points involving test ordering or dismissal as too young, sensitivity of imaging, and whether biopsy confirmed or missed the cancer; peers emphasized self-advocacy and persistence for accurate diagnosis.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},367462,1790367344,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":52,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144},1099523885074,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Ulanday et al. Breast Cancer Research (2025) 27:78  \n[https://doi.org/10.1186/s13058-025-01985-z](https://doi.org/10.1186/s13058-025-01985-z)  \nBreast Cancer Research  \n RESEARCH Open Access  \nCancers missed, women dismissed yet persist: natural language processing of online forums  \nKathleeneT. Ulanday 1,2, Maxim Topaz3, Jeanette Shekelle1, Marley Gibbons1,6, Desiree Walker4, Paula M. Castaño5, Amanda Nixon4, Stacy Lewis4, Mary Beth Terry1,2,5 and Lauren C. Houghton 1,2,5*  \nAbstract  \nObjective To identify gaps and delays in the detection of early onset cancer.  \nMethods We examined firsthand experiences shared on an online discussion board hosted by the Young Survival Coalition—an advocacy group for young adults diagnosed with breast cancer—spanning the years 2009 to 2019. We used natural language processing to detect codes: “first signs and symptoms,”“steps to diagnosis,”“healthcare interactions,”“patient-provider-system feelings,” and “staging/type.” In the training dataset, we used qualitative content analysis to code text from 750 of the forum’s 571,914 posts. We developed and evaluated automated approaches to quantify the proportion of codes in all posts. Lastly, we qualitatively reviewed the classified posts to identify areas for improvement along the clinical pathway.  \nResults The vast majority (81%) of young adults self-detected their breast cancer rather than the cancer being detected through a clinical breast exam. Young adults (70%) were dissatisfied with their care because they encountered delays at three crossroads along the clinical pathway: 1) whether the clinician ordered tests or dismissed the individual as too young; 2) whether imaging modalities were sensitive or not; 3) whether a biopsy confirmed or missed the cancer. Mental health challenges and parenting pressures compounded these delays. True positive cases who experienced these delays strongly encouraged their peers to self-advocate, persist and insist on further testing until diagnosed accurately.  \nConclusion Dismissal and delays in diagnosis of early onset breast cancer mean potentially worse prognosis  \nsince later stage cancers are more aggressive with fewer treatment options. The perspectives from survivors highlight the need for more research informing early detection in young adults by considering breast awareness, use of MRI and ultrasound, biopsy referrals for exhibited breast symptoms in the absence of positive imaging, and sociomedical support for individuals in their role as current or future parent.  \n*Correspondence:  \nLauren C. Houghton [lh2746@cumc.columbia.edu](lh2746@cumc.columbia.edu)  \n1 Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA  \n2 Columbia University Herbert Irving Cancer Center, New York, NY, USA  \n3 Columbia University School of Nursing, New York, NY, USA  \n4 Young Survival Coalition, New York, NY, USA  \n5 Columbia University Irving Medical Center, New York, NY, USA  \n6 PATH, Washington DC, USA  \nBackground  \nBreast cancer is the most common non-skin cancer malignancy in U.S. women, and its incidence, particularly for non-localized disease, has increased alarmingly in women under age 40 years, with an annual 3.6% increase in risk. [1] Since 1996 [2], only 12% of younger adults have a positive family history of breast cancer, indicating a growing trend among those without a familial predisposition.  \n© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party","cbCaijq1OfWqKoeS","https://ap.wps.com/l/cbCaijq1OfWqKoeS","pdf",1261994,"English","# Abstract\n## Objective\n## Methods\n## Results\n## Conclusion\n# Background\n## Epidemiology and screening gaps\n## Need for new guidelines\n# License and publication details","[{\"question\":\"What is the study’s main objective?\",\"answer\":\"To identify gaps and delays in the detection of early onset cancer, focusing on how young adults experience the diagnostic pathway.\"},{\"question\":\"How did the researchers analyze the online forum data?\",\"answer\":\"They used natural language processing to detect specific diagnostic-related codes and applied qualitative content analysis to code text from 750 posts in a dataset drawn from 571,914 total posts.\"},{\"question\":\"What delays did young adults report, and what effect did they have?\",\"answer\":\"Young adults described dissatisfaction with care due to delays at decision points involving test ordering or dismissal as too young, sensitivity of imaging, and whether biopsy confirmed or missed the cancer; peers emphasized self-advocacy and persistence for accurate diagnosis.\"}]","Cancers missed, women dismissed yet persist - natural language processing of online forums | PDF",1790170878,25]