More Than Eight Weeks Between Breast Cancer Diagnosis and Surgery Affects Survival

If more than eight weeks passes between early-stage breast cancer diagnosis and surgery, survival is worse.

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Mar 3, 2023

A delay of more than eight weeks between an early-stage breast cancer diagnosis and breast cancer surgery had worse outcomes in women, according to a study.

The research was published online on March 1, 2023, by the journal JAMA Surgery. Read the abstract of “Reexamining Time From Breast Cancer Diagnosis to Primary Breast Surgery.”

About the study

Previous research has suggested that letting a longer time pass between breast cancer diagnosis and surgery leads to worse survival. Still, these studies didn’t specify an exact time frame for surgery. In this study, the researchers wanted to measure how long you can wait between diagnosis and surgery before survival is affected.

The researchers looked at the records of 373,334 women diagnosed with stage I, stage II, or stage III breast cancer between 2010 and 2014.

The records came from the National Cancer Database, a database with information on more than 70% of newly diagnosed cancer cases in the United States maintained by the American College of Surgeons and the American Cancer Society.

Among the women in the study:

51.5% were ages 46 to 65
84.9% were white
10.1% were Black
53.6% had private insurance
37.7% had Medicare or other governmental insurance
5.9% had Medicaid
1.7% had no insurance
78.1% were diagnosed with hormone receptor-positive, HER2-negative breast cancer
10.1% were diagnosed with triple-negative breast cancer
8.6% were diagnosed with hormone receptor-positive, HER2-positive breast cancer
67.3% were diagnosed with low- or moderate-grade cancer
70.3% were diagnosed with node-negative breast cancer, which means no cancer was found in the lymph nodes
67.2% were diagnosed with cancers that were 2 centimeters or smaller in size
61.3% had lumpectomy or partial mastectomy
24.4% had mastectomy
14.4% had mastectomy with reconstruction

Most of the women had breast cancer surgery within six weeks of being diagnosed:

46.8% had surgery within four weeks of being diagnosed
15.4% had surgery within five weeks of being diagnosed
11.6% had surgery within six weeks of being diagnosed
8.2% had surgery within seven weeks of being diagnosed
5.7% had surgery within eight weeks of being diagnosed
3.8% had surgery within nine weeks of being diagnosed
2.5% had surgery within 10 weeks of being diagnosed
1.7% had surgery within 11 weeks of being diagnosed
1.1% had surgery within 12 weeks of being diagnosed
3.2% had surgery more than 12 weeks after being diagnosed

It’s important to know that this study didn’t include any women who were having chemotherapy before surgery, called neoadjuvant chemotherapy by doctors. Having chemotherapy before surgery usually adds several months or more to the time between diagnosis and surgery.

The researchers found no links between the time from diagnosis to surgery and overall survival until nine weeks after diagnosis.

Overall survival is how long a person lives, whether or not the cancer comes back or grows.

Women who had surgery nine or more weeks after diagnosis were more likely to die within five years than women who had surgery within four weeks of diagnosis. The results also showed that the longer the time between diagnosis and surgery, the worse survival was.

As the researchers expected, women diagnosed with breast cancers that were larger or higher grade had worse survival.

The researchers identified the factors linked to a longer time between breast cancer diagnosis and surgery. The factors included:

being younger when diagnosed
having Medicaid insurance or no insurance
having a lower household income

“We confirmed findings from other large observational studies that reported an association between surgical delay and survival by demonstrating that surgery after eight weeks (after 57 days) from diagnosis was associated with poorer survival,” the researchers wrote. “In addition, longer delays were associated with increasingly worse survival.

“Importantly, the majority of patients received surgery before this time point,” they continued. “To our knowledge, there are currently no national quality metrics for time to breast cancer surgery. Based on our findings, we recommend surgery before eight weeks from breast cancer diagnosis.”

What this means for you

If you’ve been diagnosed with breast cancer, you may feel like you have to rush to make decisions about treatments. But as this study shows, it’s possible to take the time you need to talk with your doctors and consider your options so you can make the best treatment decisions for your unique situation.

It’s very encouraging to see that nearly 90% of the women in this study had surgery within eight weeks of diagnosis.

Still, if any of the factors linked to a longer wait between diagnosis and surgery, such as being younger or having Medicaid or no insurance, apply to you, it makes sense to talk with your doctor to make sure breast cancer surgery isn’t delayed.

If you are concerned about paying for breast cancer treatment and it’s making you consider delaying surgery, there are available resources to help you. Don’t panic, and don’t skip any treatments or doctor’s visits.

Many doctors keep lists of organizations that offer financial assistance for breast cancer medicines and care, as well as local organizations that offer financial assistance for practical needs such as transportation, food, and child care. Many pharmaceutical companies have set up special funds to help pay for the cost of their medicines.