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“First Do No Harm”: Significance of Delays from Diagnosis to Surgery in Patients with Non-metastatic Breast Cancer

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Abstract

Background

The majority of patients with non-metastatic breast cancer will undergo surgery. This involves complex decisions that inevitably increase time from diagnosis to surgery beyond the currently recommended 30 days. This study aims to analyse factors that increase time to surgery and establish whether it is justifiable in the context of improved individualised breast cancer management.

Methods

A retrospective analysis of all patients at Austin Health surgically managed for non-metastatic invasive breast carcinoma between 2013 and 2019 was conducted. Time to surgery (TTS) was defined as time between informed diagnosis and cancer surgery. The patients were grouped into TTS groups of ≤30 days and >30 days. Kaplan–Meier survival analysis and Cox proportional hazards regression model were used to evaluate the impact of time interval between diagnosis and surgery.

Results

Seven hundred and thirty-one patients were included in our TTS analysis, only half of this cohort received surgery within the recommended 30 days. Many of the factors identified to be associated with increased TTS are the key to optimal management. Median follow-up for the cohort was 30 months. Between wait groups of ≤30 and >30 days, there were no significant association found between TTS and survival outcomes for DFS (HR 1.20 95% CI 0.56–2.60) and OS (HR 1.58 95% CI 0.82–3.03).

Conclusion

Breast cancer management involves complex factors that significantly increase TTS. Surgery within 30 days of diagnosis is not associated with improved DFS and OS. Outcomes from this study support a revision of current recommendations for TTS in non-metastatic breast cancer care.

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Abbreviations

BCS:

Breast conserving surgery

CT:

Computer tomography

DFS:

Disease-free survival

ER:

Oestrogen receptor

HER2:

Human epidermal growth factor receptor 2

HR:

Hazard ratio

MRI:

Magnetic resonance imaging

NCDB:

National Cancer Database

OS:

Overall survival

PR:

Rogesterone receptor

SEER-Medicare:

Surveillance, Epidemiology and End Results-Medicare

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Author information

Author notes

  1. Jennifer Xu

    Present address: Royal Melbourne Hospital, 300 Grattan St, Parkville, 3050, Australia

Authors and Affiliations

  1. University of Melbourne, Parkville, VIC, 3010, Australia

    Jennifer Xu & Luke Bromley

  2. Department of Surgery, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia

    Grace Chew

  3. Department of Surgery, Northern Health, 185 Cooper St, Epping, VIC, 3076, Australia

    Grace Chew

  4. St Vincent’s BreastScreen, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia

    Grace Chew

  5. Department of Medical Oncology, Olivia Newton John Cancer Research Institute, 145 Studley Road, Heidelberg, VIC, 3084, Australia

    Belinda Yeo

  6. Department of Medical Oncology, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia

    Belinda Yeo

  7. School of Cancer Medicine, La Trobe University, Bundoora, VIC, 3086, Australia

    Belinda Yeo

Authors
  1. Jennifer Xu
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  2. Luke Bromley
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  3. Grace Chew
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  4. Belinda Yeo
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Corresponding author

Correspondence to Jennifer Xu.

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Conflict of interest

This research project did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors. The authors declare that they have no conflict of interest.

Ethical approval

This project received ethical approval from the Austin Health Human Research Ethics Committee (HREC) 17 August 2018. The HREC confirms that the project meets the requirements of the National Statement on Ethical Conduct in Human Research (2007).

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Xu, J., Bromley, L., Chew, G. et al. “First Do No Harm”: Significance of Delays from Diagnosis to Surgery in Patients with Non-metastatic Breast Cancer. World J Surg 44, 3812–3820 (2020). https://doi.org/10.1007/s00268-020-05725-6

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  • DOI: https://doi.org/10.1007/s00268-020-05725-6

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