Time to Surgery and Breast Cancer Survival in the United States

Dec. 22, 2015

Time to Surgery and Breast Cancer Survival

Take-Home Message:

In patients with early stage breast cancer who had surgery as their first cancer treatment, survival was affected by the timing of their breast cancer surgery. Patients who had surgery within 30 days of their diagnosis did better than those who had surgery after 30 days of their diagnosis.

 

Summary

Researchers analyzed the data from the two large sources, the Surveillance, Epidemiology, and End Results (SEER)- Medicare linked database and the National Cancer Database (NCDB), to look at the effect of patients' time from their breast cancer diagnosis to their breast cancer surgery (TTS) on their overall survival from breast cancer. This study included only patients with invasive cancer in whom surgery was their first cancer treatment. It excluded patients treated with neoadjuvant chemotherapy, as well as patients with metastatic breast cancer and inflammatory breast cancer. This included data from over 200,000 patients with at least 5 years of follow-up. The time intervals chosen for TTS included <30, 31-60, 61-90, 91-120 and 121-180 days with the evaluation of survival data at 60 day intervals. 

Analysis of the data showed that TTS did influence patients' survival in early stage breast cancer, with patients having stage 1 disease obtaining the most benefit from having their surgery within 30 days after their diagnosis. (See article on about Clinical Stages of Breast Cancer.)  In Stage 1 patients, for each time interval that surgery was delayed there was an additional 1.16% decrease in 5 year overall survival. Patients with stage 2 disease saw an additional 1.09% decrease in 5 year overall survival for each additional time interval.  Patients with stage 3 disease did not have the same overall survival benefit as the earlier stage breast cancer patients as there was no significant decrease in overall survival amongst the interval groups for patients with stage 3 disease. Thus TTS for patients with early-stage invasive breast cancer is significant. 

The researchers concluded that "survival outcomes in early-stage breast cancer are affected by the length of the interval between diagnosis and surgery, and efforts to minimize that interval are appropriate. Although the effect on both overall and disease-specific survival remains small, consideration should be given to establishing reasonable and attainable goals for the timing of surgical interventions to afford this population a finite, but clinically relevant, survival benefit." 

Source: 
Time to Surgery and Breast Cancer Survival in the United States
Bleicher, RJ 
JAMA Oncol. Published online December 10, 2015. doi:10.1001/jamaoncol.2015.4508