Timing of Breast Cancer Surgery-How Much Does It Matter?

Abstract

Timing of surgical resection after breast cancer diagnosis is dependent on a variety of factors. Lengthy delays may lead to progression; however, the impact of modest delays is less clear. The aim of this study was to evaluate the impact of surgical timing on outcomes, including disease-free survival (DFS) and nodal status (NS). The cancer registry from one academic cancer hospital was retrospectively reviewed. Time from initial biopsy to surgical resection was calculated for patients with ductal carcinoma in situ (DCIS) and stage 1 and 2 invasive carcinomas. Early (0-21 days), intermediate (22-42 days), and late (43-63 days) surgery groups were evaluated for differences in NS and DFS for each cancer stage separately. A total of 3,932 patients were identified for analysis. There were no differences in DFS noted for DCIS. For stage 1, early surgery (ES) was associated with worse DFS compared to intermediate surgery (IS) (p = 0.025). There were no significant differences between ES and late surgery (LS) (p = 0.700) or IS and LS (p = 0.065). In stage II cancers, there was a significant difference in DFS in ES compared to IS (p < 0.001) and LS (p = 0.009). There was no significant difference between IS and LS (p = 0.478). Patients were more likely to undergo immediate reconstruction (p < 0.0001 for all stages) in later time-to-surgery groups, while patients in earlier groups were more likely to undergo breast conserving surgery. There was also no significant difference in NS at time of surgery in clinical stage 1 (p = 0.321) or stage 2 disease (p = 0.571). Delays of up to 60 days were not associated with worse outcomes. This study should reassure patients and surgeons that modest delays do not adversely affect breast cancer outcomes. This allows patients time to consider treatment and reconstruction options.

COVID-19 and Cancer: a Comprehensive Review

“…In instances, specifically early stage cancers where surgery is often the first step in management, patients could be offered neoadjuvant therapy, and surgery could be delayed without compromising patient outcomes [104]. Evidence suggests that 60-day delays in surgical intervention of early stage breast cancer has been documented without worsening oncological outcomes [113].…”

Adapting care for older cancer patients during the COVID-19 pandemic: Recommendations from the International Society of Geriatric Oncology (SIOG) COVID-19 Working Group

“…Delaying surgery may be appropriate for selected older patients while monitoring the cancer behavior until the outbreak is under control. For example, a 60-day delay to surgery for stage I-II breast cancer patients had no detrimental impact on outcomes in a retrospective analysis from a single academic hospital [ 46 ]. Less toxic systemic treatment such as endocrine therapy or radiotherapy may be considered means to delay surgery in selected cases, as discussed below.…”

<p>Cancer Care Management During the COVID-19 Pandemic</p>

“…75 In this context, sixty-day delays in surgical operation were not associated with poor oncological results in clinical stages I or II breast cancer. 76 Patients with lung cancer, especially after radiotherapy, may have fever, dry cough, and other symptoms such as decreased white blood cell count and ground-glass opacities in CT of the chest. 63 In light of the COVID-19 pandemic, these characteristics make it difficult to distinguish between the complications of lung cancer and those of SARS-CoV-2 infection.…”