Although patients may feel anxious waiting weeks from the time of their first doctor visit to evaluate their breast until they have breast cancer surgery, new findings from Fox Chase Cancer Center in Philadelphia show that these waits are typical in the United States. Results were published recently online in the Journal of Clinical Oncology.1
Looking at data collected from more than 72,000 Medicare patients diagnosed with nonmetastatic breast cancer, researchers—led by Richard J. Bleicher, MD, FACS, attending surgeon and Director of the Breast Fellowship Program at Fox Chase—found that, in 2005, half of the breast cancer patients underwent breast cancer surgery at least 32 days after first consulting their doctor about their breast problem. This is an increase from 1992, when half of the patients waited no more than 21 days.
Typical Wait Time
“For many Medicare patients, it can take a month or more from the time they first see their doctor to evaluate their breast concern, make a diagnosis, and get them to the operating room,” said Dr. Bleicher. “So if a woman learns that her surgery date is weeks after her evaluation, where she was found to have a breast cancer, she should know this length of time is typical, and should not be concerned.”
He added, “Although this interval may sound alarming at first, it does not appear to have a detrimental effect on outcomes. We don’t have the outcomes data for this group of patients yet, but we have seen improvements in survival over the past few decades in breast cancer overall.”
Before this study, Dr. Bleicher explained, it was unclear how long people were actually waiting for surgery and how the surgery type and workup affected that wait. Experts had data from individual institutions, but nothing that captured waiting times nationwide. So when patients got anxious hearing their surgery was weeks away, doctors were unable to tell them whether such wait times were longer than the norm, and thus potentially dangerous.
Reasons for Longer Delays
“It’s not clear why people are waiting longer for surgery,” said Dr. Bleicher. Now that patients have access to more information about cancer, they may take longer to make decisions about surgery; alternatively, a larger patient population could be filling operating rooms, making it harder to schedule surgeries. Indeed, patients undergoing more complicated procedures—such as mastectomy with breast reconstruction—waited longer than average.
Longer delays were also seen in patients who received certain types of biopsies and imaging. This suggests that part of the increase in wait time may stem from greater use of a wider variety of current tools to detect and image the tumors before surgery, said Dr. Bleicher. This may also explain why patients may be living longer, even though the time from presentation to their doctor until surgery steadily increased from 1992 to 2005.
“Patients should be aware that even though breast cancer feels like an emergency needing to be addressed tomorrow, it doesn’t have to be dealt with in a matter of days,” said Dr. Bleicher. “These results should reassure women that, if they are not in the operating room tomorrow, that’s typical.”
He added that the findings apply only to patients receiving Medicare, and wait times may differ for those with private insurance or no insurance at all. ■
Disclosure: The authors reported no potential conflicts of interest.
1. Bleicher RJ, Ruth K, Sigurdson ER, et al: Preoperative delays in the US Medicare population with breast cancer. J Clin Oncol. November 19, 2012 (early release online).