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Analysis Recommends Starting Treatment Within Two Months of Diagnosis

Report shows increased risk of breast cancer-related death only with more than two month wait

January 22, 2013

Written By Nicole Katze, MA, Editor and Manager, Publications
Reviewed By Lisa Jablon, MD

Women who waited more than 60 days after a late-stage breast cancer diagnosis were 85 percent more likely to die from the disease than women who began treatment sooner, a retrospective analysis of medical records showed. For this study, late-stage included any cancer that traveled to lymph nodes, regardless of cancer stage.

Waiting to start treatment for early-stage cancer did not seem to impact the risk of breast cancer-related death. Early-stage was defined as ductal carcinoma in situ or invasive cancer confined to the breast.

Study Background

Past studies suggest that the longer women wait to start treatment for breast cancer, the worse the outcome. However, newer research conflicts with those results.

The researchers on this study believe the differences between past and recent findings stem from unclear or varied definitions of ā€œdelay.ā€ Some studies count the delay from when a woman first notices symptoms of breast cancer, while others count it from the day of confirmed diagnosis.

To gain a clearer understanding of how delaying treatment impacts overall survival, the investigators analyzed the time from biopsy-confirmed diagnosis to the start of treatment, and the length of time women lived. Overall survival is the time from diagnosis until death from any cause; breast cancer-specific survival is the time from diagnosis until death from the disease.

Study Design

This study is a retrospective analysis, or analysis of data collected from past medical records. Women were part of the North Carolina Central Cancer Registry ā€“ Medicaid Claims database. They were 18 years old or older and diagnosed between January 1, 2000, and December 31, 2002. All were enrolled in the North Carolina Medicaid program, a health insurance program for low-income individuals and families, for at least six months before diagnosis.

The records of 1,786 women were followed until death or July 31, 2006. The researchers analyzed the time from diagnosis to treatment start, and overall survival rates. They also explored other factors, including age, race, cancer stage, and tumor characteristics.

Results

The median age of participants was 61.6 years, and time to treatment ranged from 0 to 122 days. Most women started treatment within one month of diagnosis; almost all started treatment within the first two months. The median follow-up time was 4.7 years.

The women more likely to have longer spans of time between diagnosis and start of treatment:

  • were non-white
  • were from cities
  • had not had home health care in the past
  • had additional biopsies, hospital stays, or emergency department admittance between diagnosis and treatment

Survival data showed that:

  • 144 of 247 deaths (58 percent) were breast cancer-related, of which 114 were categorized as late-stage breast cancer
  • Women with late-stage cancers who waited more than 60 days to start treatment had worse overall survival (66 percent increase) and breast cancer-specific survival (85 percent increase) than those who started treatment earlier
  • Delaying treatment for more than 60 days for women categorized as  having early-stage breast cancer did not seem to impact survival rates

Limitations

These findings reflect a very specific group of low-income women in North Carolina. Although the results suggest a potentially important negative effect of delaying treatment for women with breast cancer in the lymph nodes, the delay in treatment did not seem to have a negative impact on women with earlier-stage tumors.

More research needs to be done, and the researchers suggest future studies focus on diverse populations, delays in treatment, and the impact of the stage at diagnosis.

Because retrospective studies rely on past medical records, errors in record-keeping or missing data may sometimes skew results.

What This Means For You

In most cases a breast cancer diagnosis is not an emergency; even in this study, women did not have worse survival if they started treatment within two months of diagnosis. But this study suggests that beginning treatment within this time frame may increase the chances of longer survival for those with lymph node-positive cancers.

If you were recently diagnosed with breast cancer of any stage, talk with your doctor about these findings and your treatment options. Ask what information you need to make treatment decisions, and agree on a reasonable time frame for you to feel comfortable about your choices. You might also find helpful information in our guides for newly diagnosed women and women with stage IV breast cancer.

McLaughlin, John M., Anderson, Roger T., et al.: Effect on Survival of Longer Intervals Between Confirmed Diagnosis and Treatment Initiation Among Low-Income Women With Breast Cancer. J Clin Oncol (November 19, 2012).

Denver, CO  ·  September 13, 2014

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