Delays of more than 6 weeks from time of diagnosis until surgical treatment of breast cancer among young women significantly decreases survival times compared to those with a shorter treatment delay time, according to a study in JAMA Surgery. “This adverse impact on survival was more pronounced in African American women, those with public or no insurance,” and those with low socioeconomic status, the authors reported.
The retrospective case-only study looked at 8,860 breast cancer cases diagnosed between 1997 and 2006 and included in the California Cancer Registry, part of the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) program. “In contrast to some of the previous studies, we focused only on women younger than 40 years, where breast cancer is rare but mortality is high mainly because of aggressive biologic and pathologic characteristics of tumors specific to this age group,” the authors explained.
Time to treatment delay was defined as the number of weeks between pathologic diagnosis and the date of definitive treatment, either earliest definitive surgery (partial mastectomy including lumpectomy, subcutaneous mastectomy, total [simple] mastectomy, modified radical mastectomy, radical mastectomy, extended radical mastectomy, and mastectomy not otherwise specified); or definitive chemotherapy given as the first course of treatment (including neoadjuvant chemotherapy followed by surgery).
“The 5-year survival in women who were treated by surgery and had [treatment delay time] more than 6 weeks was 80% compared with 90% (P = .005) in those with [treatment delay time] less than 2 weeks,” the investigators stated.
Treatment delays of more than 6 weeks differed significantly (P < .001) between racial/ethnic groups—15.3% for Hispanics and for African Americans compared to 8.1% for non-Hispanic whites. A treatment delay greater than 6 weeks was more likely among women with public or no insurance (17.8%) than those with private insurance (9.5%), and women with low socioeconomic status (17.5%) than high socioeconomic status (7.7%). On multivariate analysis, significant risk factors for shorter survival included longer treatment delay, estrogen receptor–negative status, having public or no insurance, and late cancer stage, the researchers reported.
“Our study examined surgical delay time, which is a physician-related delay, after the diagnosis of breast cancer was established,” the authors wrote, while noting that surgical delay “can be affected by other patient-related factors such as insurance status and [socioeconomic status],” or, if the diagnosis was made during pregnancy, waiting until after the birth of the baby to start treatment.
It would also be important, the authors added, “to examine physician-related delay prior to the diagnosis of breast cancer since there are many anecdotal stories of young women who presented to their primary care physicians on numerous occasions prior to being diagnosed with breast cancer. From our literature search, we did not find any studies examining physician-related delay prior to the diagnosis of breast cancer in a large cohort of young women.”
The investigators concluded, “it is crucial to prevent further physician-related delays before and after the diagnosis of breast cancer is established to maximize the survival of these young women who are in the most productive time of their life.” ■
Smith EC, et al: JAMA Surg. April 24, 2013 (early release online).