“First Do No Harm”: Significance of Delays from Diagnosis to Surgery in Patients with Non‐metastatic Breast Cancer

Xu, Jennifer; Bromley, L.; Chew, Grace; Yeo, Belinda

doi:10.1007/s00268-020-05725-6

Cited by 6 publications

(15 citation statements)

References 29 publications

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“…Like many others, we found that preoperative MRI was a significant factor in delaying TTS 5,6,11,12,17 and added an extra 12 days on average. Hulvat et al similarly found that the addition of MRI added an average of 11 days to TTS.…”

Section: Discussionsupporting

confidence: 83%

“…19 Our findings that patient age and race were not significant drivers influencing TTS are reassuring. These findings are mirrored by some, 6,10,12,16 but not by others. 4,5,7,20 We also found that tumor characteristics such as palpability, lymph node status, histologic subtype, and receptor profile had no impact on TTS.…”

Section: Discussionmentioning

confidence: 81%

“…3 As a result, many have considered TTS ≤30 as a standard by which to measure ourselves. 5,6,10 Others, however, have found that survival is only affected after longer periods, 5,11 and some could find no impact of TTS on survival 6,12 regardless of time interval. 13 We chose to consider TTS ≤30 days as the outcome measure for this study for several reasons.…”

Section: Discussionmentioning

confidence: 99%

“…Contrary to our findings, some have found that patients who present with symptomatic disease (vs non-palpable findings) have a longer TTS. 10,12,16 It is possible that we did not appreciate the impact of palpability on TTS given that the vast majority of our patients presented with non-palpable disease. Several authors found, as we did, that lymph node status and/or stage did not affect TTS 6,12,16 ; however, this was not a universal finding.…”

Section: Discussionmentioning

confidence: 99%

“…Many other authors have similarly found that an average TTS of 30 days (+/− 5 days) in their cohorts. 2,4-7,12,15…”

Section: Discussionmentioning

confidence: 99%

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Factors Affecting Time to Surgery in Breast Cancer Patients

Chagpar

Howard-McNatt

Chiba

et al. 2021

The American Surgeon

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Background We sought to determine factors affecting time to surgery (TTS) to identify potential modifiable factors to improve timeliness of care. Methods Patients with clinical stage 0-3 breast cancer undergoing partial mastectomy in 2 clinical trials, conducted in ten centers across the US, were analyzed. No preoperative workup was mandated by the study; those receiving neoadjuvant therapy were excluded. Results The median TTS among the 583 patients in this cohort was 34 days (range: 1-289). Patient age, race, tumor palpability, and genomic subtype did not influence timeliness of care defined as TTS ≤30 days. Hispanic patients less likely to have a TTS ≤30 days ( P = .001). There was significant variation in TTS by surgeon ( P < .001); those practicing in an academic center more likely to have TTS ≤30 days than those in a community setting (55.1% vs 19.3%, P < .001). Patients who had a preoperative ultrasound had a similar TTS to those who did not (TTS ≤30 days 41.9% vs 51.9%, respectively, P = .109), but those who had a preoperative MRI had a significantly increased TTS (TTS ≤30 days 25.0% vs 50.9%, P < .001). On multivariate analysis, patient ethnicity was no longer significantly associated with TTS ≤30 ( P = .150). Rather, use of MRI (OR: .438; 95% CI: .287-.668, P < .001) and community practice type (OR: .324; 95% CI: .194-.541, P < .001) remained independent predictors of lower likelihood of TTS ≤30 days. Conclusions Preoperative MRI significantly increases time to surgery; surgeons should consider this in deciding on its use.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Many other authors have similarly found that an average TTS of 30 days (+/− 5 days) in their cohorts. 2,4-7,12,15…”

Section: Discussionmentioning

confidence: 99%

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Factors Affecting Time to Surgery in Breast Cancer Patients

Chagpar

Howard-McNatt

Chiba

et al. 2021

The American Surgeon

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The impact of the COVID-19 pandemic in the clinical assistance to breast cancer patients

Ribeiro,

Peleteiro,

Fougo

2023

Cancer Causes Control

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Purpose We aimed to disclose the impact of the pandemic on breast cancer patients in a specialized breast cancer center (BCC). Methods A total of 501 breast cancer patients with a first appointment in the BCC from April 1st, 2019 to March 31st, 2021 were divided into four consecutive periods of 6 months. Data from the homologous semesters was compared. Patients with an appointment in the BCC during the study period were eligible for the secondary aim of our study (BCC workload). Results After the pandemic declaration (period 3), we found a decrease in the referral by screening programs (p = 0.002) and a reduction in the waiting time between the primary care referral and the first BCC appointment (p < 0.001). There were higher rates of palpable axillary nodes (p = 0.001), an increase in N stage 2 and 3 (p = 0.050), and a trend for primary endocrine therapy as the first treatment (p = 0.021) associated with higher rates of complete axillary node dissection (p = 0.030). In period 4, there were more outward diagnoses (p = 0.003) and a higher rate of surgery as the first treatment (p = 0.013). Conclusion COVID-19 pandemic implied a more advanced nodal stage, which may be related to the delay in breast cancer screening. Graphical abstract

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Surgical management of breast cancer in Victoria: A state‐wide audit

Sung

Muthusamy

Finn

et al. 2022

Asia-Pac J Clncl Oncology

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Aim The Victorian Tumour Summits are an initiative of the Victorian Integrated Cancer Services to engage clinicians and consumers in identifying unwarranted variations in cancer care across the state. From the analysis presented at the Victorian Breast Tumour Summit in 2021, this study provides a state‐wide overview of epidemiology and surgical care of breast cancer in Victoria to outline any variations in care across the state, and limitations in data reporting, which impacts the understanding of breast cancer burden and service planning. Methods A retrospective analysis of Victorian breast cancer patients diagnosed between 2016 and 2018 was performed using a linked data set provided by the Department of Health. The linked data sources include Victorian Cancer Registry, Victorian Admitted Episodes Dataset and Victorian Radiotherapy Minimum Data Set, from which patient demographic details, tumor characteristics and treatment records were extracted. Pearson's chi‐squared test was used to determine the statistical significance of relationships between various categorical parameters. Variables including demographics, types of surgery (breast‐conserving vs. mastectomy), rates of neoadjuvant chemotherapy, and time to surgery were examined. Results One thousand nine hundred thirty‐seven patients with ductal carcinoma in situ and 13,375 patients with invasive breast cancer (IBC) were included. Of 11,351 patients with stages I‐III IBC (85%, N = 13,375) 66% underwent breast‐conserving surgery (BCS), and 31% underwent mastectomy. The ratio of mastectomy to BCS increased with increasing disease stage. Neoadjuvant chemotherapy was utilized in 11% of early IBC patients who were surgically treated. Eighty‐three percent of patients undergoing upfront breast surgery were treated within 5 weeks of diagnosis, with a significant difference in the median time to surgery between public and private sectors. Breast reconstruction was performed in 37% of mastectomy patients, of whom 83% underwent immediate breast reconstruction, and 17% underwent delayed breast reconstruction. Conclusions Victorian breast cancer data show a high quality of surgical care coordination. Significant gaps in our data warrant future improvements in the Victorian breast cancer notification system and access to pharmaceutical data for an enhanced understanding of the breast cancer treatment pathways and care delivery.

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“First Do No Harm”: Significance of Delays from Diagnosis to Surgery in Patients with Non‐metastatic Breast Cancer

Cited by 6 publications

References 29 publications

Factors Affecting Time to Surgery in Breast Cancer Patients

Factors Affecting Time to Surgery in Breast Cancer Patients

The impact of the COVID-19 pandemic in the clinical assistance to breast cancer patients

Surgical management of breast cancer in Victoria: A state‐wide audit

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