Surgery before 8 weeks not associated with worse survival in breast cancer

Women who had surgery up to 8 weeks after breast cancer diagnosis did not have worse overall survival than those with earlier times to surgery, according to a case series with more than 373,000 women published in JAMA Surgery.

In addition, researchers found that delaying breast cancer surgery to 8 weeks after diagnosis may be associated with social determinants of health.

“It is necessary to identify a specific safe interval to surgery to better understand how we might balance allowing adequate time for decision-making and identifying potential detrimental delays that may disproportionally affect patients,” Alyssa A. Wiener, MD, general surgery resident in the Wisconsin Surgical Outcomes Research Program at the University of Wisconsin School of Medicine and Public Health, Madison, and colleagues wrote.

This case series study included data from 373,334 women (median age, 61 years) identified using data from the National Cancer Database who were diagnosed with stage I to stage III ductal or lobular breast cancer from 2010 to 2014 with 5-year follow-up to 2019. All women underwent surgery as the first treatment course. Researchers identified factors associated with longer time to surgery using surgery performed 30 days or less from breast cancer diagnosis as the reference group.

The primary outcome was overall survival among women with breast cancer.

Compared with 1 to 30 days, time to surgery and overall survival had no statistically significant association for 0 to 4 weeks, 5 weeks (HR = 0.97; 95% CI, 0.93-1.01; P = .11), 6 weeks (HR = 1; 95% CI, 0.96-1.04; P = .93), 7 weeks (HR = 1; 95% CI, 0.95-1.05; P = .9) and 8 weeks (HR = 1.03; 95% CI, 0.98-1.1; P = .24). However, time to surgery 9 weeks or later following breast cancer diagnosis was associated with worse overall survival (HR = 1.15; 95% CI, 1.08-1.23; P < .001).

Longer time to surgery was significantly associated with younger age. For example, compared with women older than 75 years, those aged 45 years or younger were more likely to undergo surgery 31 to 60 days after diagnosis (adjusted OR = 1.32; 95% CI, 1.28-1.38), 61 to 74 days after diagnosis (aOR = 1.64; 95% CI, 1.52-1.78) and more than 74 days after diagnosis (aOR = 1.58; 95% CI, 1.46-1.71),

Similarly, women who were uninsured or had Medicaid were more likely than those with private insurance to have surgery 31 to 60 days after diagnosis (aOR = 1.35; 95% CI, 1.3-1.39), 61 to 74 days after diagnosis (aOR = 2.13; 95% CI, 2.01-2.26) and more than 74 days after diagnosis (aOR = 3.42; 95% CI, 3.25-3.61).

In addition, those with neighborhood household annual income of less than $38,000 vs. higher were more likely to have longer times to surgery: 31 to 60 days after diagnosis (aOR = 1.35; 95% CI, 1.02-1.07), 61 to 74 days after surgery (aOR = 1.21; 95% CI, 1.15-1.27) and more than 74 days after surgery (aOR = 1.53; 95% CI, 1.46-1.61).

“Identifying 8 weeks as a goal for time to surgery allows tracking of those patients with prolonged delays and can target resources to identifying actionable delays possibly associated with socioeconomic factors,” the researchers wrote. “Prospective tracking of these patients and further examination are needed to identify unacceptable delays that may affect resource-limited patients.”