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Delayed Time to Surgery Reduces Survival Rates in Young Women

July 24, 2013

Written By Robin Warshaw
Reviewed By Cynthia M. Mojica, PhD

Young women whose surgery-only treatment for breast cancer is delayed longer than 6 weeks from diagnosis have decreased survival rates compared with women treated sooner, a recent study found.

The research, drawn from a large database of Californian women, was published in JAMA Surgery.

Background and Reason for the Study

Women diagnosed with breast cancer between ages 15 and 39 have a lower 5-year survival rate than older women. This difference has been linked to more aggressive tumor types found in some young women.

Few studies have focused on other possible factors, including time delay from diagnosis to treatment, race/ethnicity and socioeconomics, which could contribute to lower survival rates.

The researchers wanted to find out whether treatment delay time (TDT), age, race/ethnicity, socioeconomic level, health insurance coverage, or cancer stage influenced survival rates of young women.

Study Structure

The researchers studied cancer registry data from 8,860 young Californian women diagnosed from 1997 to 2006.

TDT was measured by the number of weeks since tests confirmed diagnosis to the earliest definitive surgery (not biopsy) or chemotherapy treatment. Delay time groups were less than 2 weeks, 2 to 4 weeks, 4 to 6 weeks, or more than 6 weeks.

The treatments evaluated were

  • surgery only (lumpectomy, mastectomy)
  • chemotherapy before (neoadjuvant) surgery
  • surgery before chemotherapy

The researchers also considered

  • age: 15 to 29 years, 30 to 39 years
  • race/ethnicity: African-American, Asian, Hispanic, non-Hispanic Caucasian
  • socioeconomic status (SES): five groups by census data, from 1 (lowest) to 5 (highest)
  • insurance: public (including Medicaid and no insurance), private (including military), and unknown

Other data included cancer stage, tumor markers and lymph node status, among other factors.

Among the women whose data was studied, 49.8 percent were Caucasian; 27.7 percent Hispanic; 13.8 percent Asian; and 8.1 percent African-American. At diagnosis, the women’s cancers were found to be

  • stage I        28.3 percent
  • stage II       53.5 percent
  • stage III      15.4 percent
  • stage IV       2.8 percent

Findings

Overall, the average treatment delay was 2.7 weeks. But African-American and Hispanic women had higher rates of delay of more than 6 weeks, a finding that was statistically significant, or unlikely to have happened by chance. TDT of greater than 6 weeks was also more likely with low SES, public or no insurance, and stage III or IV breast cancer.

The 5-year survival rate was also affected by delay. Women with a TDT of more than 6 weeks

  • had a 78 percent survival rate compared with 84 percent for those delayed less than 2 weeks
  • had survival differences by race—African-Americans had the poorest survival rate (57 percent) compared with Hispanic (74 percent), Asian (81 percent) and Caucasian (86 percent) women

Decreased survival risk was also associated with estrogen-receptor negative status.

The greatest difference in survival by treatment type was seen in the surgery-only group—80 percent survival with TDT of more than 6 weeks vs. 90 percent with TDT of less than 2 weeks. A lengthy delay before having surgery alone is a “significant risk for reduced survival,” the researchers found.

Reasons for surgery delay were not given, but the researchers noted delays in scheduling surgery might occur if women lack insurance or other means of payment. Women diagnosed when pregnant might also delay surgery, but participants’ pregnancy status was not known. 

Study Limitations

This study focused on treatment delay after breast cancer was diagnosed. Researchers did not study the pre-diagnosis delays many young women experience.

The researchers stressed the need for future study of physician-related delay before diagnosis and after.

What This Means for You

Your decisions about time to treatment should be planned with your doctor based on what course is best for you. Talk with your breast surgeon or healthcare provider about your time-delay concerns and other questions you might have about how your income, health insurance status, or other factors could affect your time to treatment.

If you are facing barriers to prompt breast cancer treatment, call your county or state health department.You can also download a free copy of LBBC’s Guide to Understanding Financial Concerns to find out about help with medical costs, or call our toll-free Breast Cancer Helpline at (888) 753-LBBC (5222).  

Smith, EC, Ziogas, A, Anton-Culver, H. Delay in surgical treatment and survival after breast cancer diagnosis in young women by race/ethnicity. JAMA Surgery. 2013; doi: 10.1001/jamasurg.2013.1680

This article was supported by Cooperative Agreement Number DP11-1111 from The Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.

Denver, CO  ·  September 13, 2014

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