April 24, 2013

A new study of California women finds that women who wait six weeks or more after diagnosis to have surgery or begin chemotherapy have significantly decreased survival time compared with those who have a shorter time between diagnosis and treatment. This adverse impact on survival was more pronounced in African Americans, women with public or no insurance, and those with low SES. Researchers from the University of California, Irvine, and Children's Hospital of Orange County studied breast cancer patients between ages 15 and 39 (designated as adolescents and young adults or AYA), who account for only 5% to 6% of all breast cancer patients, but whose cancers are typically more aggressive and therefore at increased urgency for early treatment. The retrospective case-only observational study included 8,860 AYA breast cancer cases diagnosed in California from 1997 to 2006 using the California Cancer Registry database. The California Cancer Registry is part of the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program, with standardized data collection and quality control protocols since 1988. Records in the database showed which women began treatment within two weeks of diagnosis and which women waited at least six weeks for treatment.

The researchers found that treatment delay time (TDT) of more than 6 weeks after diagnosis was significantly different (P < .001) between racial/ethnic groups (Hispanic, 15.3% and African American, 15.3% compared with non-Hispanic white, 8.1%). Women with public or no insurance (17.8%) compared with those with private insurance (9.5%) and women with low socioeconomic status (17.5%) compared with those with high socioeconomic status (7.7%) were shown to have TDT more than 6 weeks. The 5-year survival in women who were treated by surgery and had TDT more than 6 weeks was 80% compared with 90% (P = .005) in those with TDT less than 2 weeks. In multivariate analysis, longer TDT, estrogen receptor negative status, having public or no insurance, and late cancer stage were significant risk factors for shorter survival.

Smith EC, Ziogas A, Anton-Culver H. Delay in Surgical Treatment and Survival After Breast Cancer Diagnosis in Young Women by Race/Ethnicity. JAMA Surg 2013 Apr 24:1-8. [Epub ahead of print] (PubMed)