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High-Risk Breast Cancers Should be Treated Earlier

Study shows survival rates improve for those with stage III triple-negative and HER2-positive breast cancers when chemotherapy is started earlier

March 11, 2014

Written By Nicole Katze, MA, Editor and Manager, Content Development
Reviewed By Matthew J. Ellis, BSc, MB, BChir, PhD, FRCP

Women with stage III breast cancer or who are diagnosed with triple-negative or HER2-positive disease may live longer when starting chemotherapy no more than 30 days after surgery, research shows. 

These findings, published in a recent issue of Journal of Clinical Oncology, suggest beginning post-surgery chemotherapy sooner should be a priority in treating those with high-risk tumors.

Background and Goals

Most people begin chemotherapy within a few weeks of surgery to remove breast cancer. Yet, there are no guidelines suggesting exactly how long after surgery treatment should start. Doctors also do not know whether waiting longer impacts how well chemotherapy works.

Past studies have shown certain groups of people need to delay the start of treatment more often than others. People on Medicare, those from low-income areas and racial minorities tend to wait the longest.

The trial team wanted to know what impact delaying post-surgery chemotherapy had on different survival outcomes, including:

  • Overall survival (OS), the time from the start of chemotherapy to death from any cause
  • Relapse-free survival (RFS), the time from the start of chemotherapy to the cancer coming back in the breast, lymph nodes or a distant part of the body
  • Distant relapse-free survival (DRFS), the time from the start of chemotherapy to the cancer coming back in a distant part of the body


Investigators collected data from 6,827 medical records in the Breast Medical Oncology Institutional Database of the University of Texas MD Anderson Cancer Center. The records pulled were grouped according to the amount of time that passed between women having surgery and starting chemotherapy. These groups were:

  • 30 days or fewer from surgery (2,716 women)
  • 31 to 60 days from surgery (2,994 women)
  • 61 days or more from surgery (1,117 women)

The records also contained information on age, race, type of breast cancer, cancer stage, and for HER2-positive women, treatment with trastuzumab (Herceptin).


Overall, the trial team found that OS, RFS, and DRFS were not significantly different across groups. However, when the data was viewed by type of breast cancer and stage of disease, analysis showed:

  • Women with stage III disease had a 76 percent greater risk of death when they began chemotherapy 61 or more days after surgery, compared with women starting 30 or fewer days after surgery. Their risk of RFS and DRFS was also greater.
    • Stage III disease refers to cancer that travels beyond the breast to nearby lymph nodes, muscle or tissue, though not to distant organs. In such cases, starting chemotherapy before surgery may be best to help destroy the cancer both inside and outside of the breast. This use of chemotherapy is called neoadjuvant.
  • Women with triple-negative disease who began chemotherapy after 31 days or more had a significantly greater risk of death compared with those starting 30 days or sooner post-surgery.
  • Women with HER2-positive disease already treated with trastuzumab had a greater risk of death when they started chemotherapy 61 or more days after surgery.
    • The time to treatment did not impact survival for women who were not treated with trastuzumab.

Triple-negative and HER2-positive breast cancers have a greater chance of coming back after treatment. For this reason, researchers suggested it was not surprising that more immediate treatment with chemotherapy following surgery increased survival rates among women with these types of breast cancers.

What This Means for You

The results of this study suggest that while the time to the start of post-surgery chemotherapy may not change survival outcomes for all women with breast cancer, those who have certain diagnoses may benefit from starting treatment sooner.

If you have stage III breast cancer or were diagnosed with triple-negative or HER2-positive disease, the findings of this study show that starting chemotherapy as soon as possible after surgery may be a good option for you.

If you and your doctor are working on a treatment plan, it’s OK to share these findings with him or her as you move forward. Your doctor will be able to recommend the treatment schedule that is best for you.

To learn more about making breast cancer care decisions, read our Guide to Understanding Treatment Decisions.

De Melo Gagliato, D, Gonzalez-Angulo, AM, Lei, X, Theriault, R, Giordano, SH, et al. Clinical Impact of Delaying Initiation of Treatment of Adjuvant Chemotherapy in Patients With Breast Cancer. Journal of Clinical Oncology (January 2014) doi: 10.1200/JCO.2013.49.7693