Time from breast cancer diagnosis to therapeutic surgery and breast cancer prognosis: A population‐based cohort study

Abstract

Theoretically, time from breast cancer diagnosis to therapeutic surgery should affect survival. However, it is unclear whether this holds true in a modern healthcare setting in which breast cancer surgery is carried out within weeks to months of diagnosis. This is a population- and register-based study of all women diagnosed with invasive breast cancer in the Stockholm-Gotland healthcare region in Sweden, 2001-2008, and who were initially operated. Follow-up of vital status ended 2014. 7,017 women were included in analysis. Our main outcome was overall survival. Main analyses were carried out using Cox proportional hazards models. We adjusted for likely confounders and stratified on mode of detection, tumor size and lymph node metastasis. We found that a longer interval between date of morphological diagnosis and therapeutic surgery was associated with a poorer prognosis. Assuming a linear association, the hazard rate of death from all causes increased by 1.011 (95% CI 1.006-1.017) per day. Comparing, for example, surgery 6 weeks after diagnosis to surgery 3 weeks after diagnosis, thereby confers a 1.26-fold increased hazard rate. The increase in hazard rate associated with surgical delay was strongest in women with largest tumors. Whilst there was a clear association between delays and survival in women without lymph node metastasis, the association may be attenuated in subgroups with increasing number of lymph node metastases. We found no evidence of an interaction between time to surgery and mode of detection. In conclusion, unwarranted delays to primary treatment of breast cancer should be avoided.

A systematic review and meta-analysis of surgery delays and survival in breast, lung and colon cancers: Implication for surgical triage during the COVID-19 pandemic

“…OS was reported in twelve breast cancer studies; including eleven analyses of non-stage specific (multiple stage) disease 29 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ; four of stage I only disease 39 , 41 , 42 , 45 ; four of stage II only disease 39 , 41 , 42 , 45 ; and three of stage III only disease. 39 , 41 , 42 Sample sizes ranged from 1702 to 420,792 with a mean of 176,657 patients.…”

Impact of preoperative wait time on survival in patients with clinical stage II/III gastric cancer

“…Conversely, Roland et al found no association between pretreatment wait time and survival [23]. A significant correlation between preoperative wait time and survival has been demonstrated in only breast cancer [4][5][6][7]. Bleicher et al reported that OS worsened with increasing preoperative wait time in five intervals (≤ 30, 31-60, 61-90, 91-120, and 121-180 days) [4].…”

“…Bleicher et al reported that OS worsened with increasing preoperative wait time in five intervals (≤ 30, 31-60, 61-90, 91-120, and 121-180 days) [4]. Eriksson et al reported a linear association between preoperative wait time and survival [5]. Hence, there are varying results with regard to the association between preoperative wait time and survival among cancer types, and this is probably because of different tumor characteristics and different treatments.…”

“…There is a concern that a delay in cancer treatment can lead to a poor survival outcome. Indeed, previous large cohort studies showed an association between a long preoperative wait time and poor survival in breast cancer patients [4][5][6][7]. However, such a tendency has not been shown in other cancer types, including gastric cancer.…”

Treatment for breast cancer patients during the special period of novel coronavirus pneumonia outbreak

“…The most anxiety-provoking time for patients is the period from diagnosis to treatment initiation [4]. Moreover, previous studies [1,3,10,16] have suggested the length of the interval between diagnosis and surgery could affect the survival outcomes in early stage breast cancer. Thus, patients with early stage breast cancer should receive surgery as soon as possible.…”