Time-to-surgery and overall survival after breast cancer diagnosis in a universal health system
It is unclear whether time between breast cancer diagnosis and surgery is associated with survival and whether this relationship is affected by access to care. We evaluated the association between time-to-surgery and overall survival among women in the universal-access U.S. Military Health System (MHS).
Women aged 18–79 who received surgical treatment for stages I–III breast cancer between 1998 and 2010 were identified in linked cancer registry and administrative databases with follow-up through 2015. Multivariable Cox regression models were used to estimate risk of all-cause death associated with time-to-surgery intervals.
The study included 9669 women with 93.1% survival during the study period. The hazards ratios (95% confidence intervals) of all-cause death associated with time-to-surgery were 1.15 (0.93, 1.42) for 0 days, 1.00 (reference) for 1–21 days, 0.97 (0.78, 1.21) for 22–35 days, and 1.30 (1.04, 1.61) for ≥ 36 days. The higher risk of mortality associated with time-to-surgery ≥ 36 days tended to be consistent when analyzed by surgery type, age at diagnosis, and tumor stage.
In the MHS, longer time-to-surgery for breast cancer was associated with poorer overall survival, suggesting the importance of timeliness in receiving surgical treatment for breast cancer in relation to overall survival.
KeywordsLumpectomy Mastectomy Breast surgery Overall survival Clinical outcomes
Central Cancer Registry
Current Procedural Terminology
Facility Oncology Registry Data Standards
Healthcare Common Procedure Coding System
International Classification of Diseases
Military Health System Data Repository
Military Health System
Surveillance, Epidemiology, and End Results Program
The authors thank the Joint Pathology Center and Defense Health Agency for providing the data used in this study.
The contents of this publication are the sole responsibility of the authors and do not reflect the views, assertions, opinions or policies of the Uniformed Services University of the Health Sciences (USUHS), the Department of Defense (DoD), or the Departments of the Army, Navy, or Air Force, or any other agency of the U.S. Government, or the Henry M. Jackson Foundation (HJF). Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government.
This project was supported by the Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center under the auspices of the Henry M. Jackson Foundation for the Advancement of Military Medicine.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The data linkage project was reviewed and approved by the institutional review boards of the Walter Reed National Military Medical Center and the Defense Health Agency for compliance with ethical standards. All study activities were conducted in accordance with the ethical standards of the institutional review boards and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. It was determined by the institutional review boards that formal consent was not required for this type of study.
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