As the authors point out, achieving surgery in less than 30 days is difficult and therefore 30 days might be an unrealistic goal, particularly when immediate reconstruction after mastectomy is being considered and when imaging techniques and more extensive workups can cause delays that easily stretch beyond 30 days, particularly for patients seeking multiple opinions. Possible explanations for these effects include accelerated growth of micrometastases after resection of the primary tumor, increased tumor angiogenesis, or development of primary resistance.
A 2016 study published in JAMA Oncology looked at data from over 115,000 people (between 2003 and 2005) via the National Cancer Database (NCDB). Some of the research can be confusing (especially when you are newly diagnosed and just learning about things such as HER2), but having an understanding of your particular cancer and your individual preferences are important in making an educated choice about the best timing for your treatment. Time to learn about your diagnosis and choose the best surgeon. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Surprisingly, uninsured people had faster times to initiation of treatment. You will need time to heal after surgery and time to rest after any treatment. So the longer women delayed surgery, the worse survival they had. How Long Can You Wait to Have Treatment for Breast Cancer? Furthermore, it is possible that the time to chemotherapy (TTC) has a different effect according to tumor subtype, tumor stage, and tumor grade. Read the abstracts of: Doctors call treatments given after surgery adjuvant treatments. The average diameter and volume of tumors at diagnosis was 14.7 millimeters and 1.3 centimeters vs. 15.6 millimeters and 1.6 centimeters. https://doi.org/10.1371/journal.pone.0213209. After all, if a conventional treatment didn’t work, it wouldn’t matter how long you waited to administer it. The conclusion was that although time is needed to discuss treatment options and prepare, earlier surgery is better. National Center for Complementary and Integrative Health, Steven P. Novella, MD – Founder and Executive Editor, David H. Gorski, MD, PhD – Managing Editor, Science-Based Medicine’s Not-So-Psychic Predictions for 2016, part-serious, part-facetious predictions for 2016, One study (Bleicher et al) comes from Fox Chase Cancer Center, other (Chavez-MacGregor et al) is from the M.D. And not everyone feels quite ready to have surgery right after being diagnosed.
2014. Our part-serious, part-facetious predictions for 2016 notwithstanding, one thing about 2016 is certain: I will almost certainly encounter some form of cancer quackery or other and deconstruct it, probably multiple forms. DOI: 10.1371/journal.pone.0201288. Both find a detrimental effect due to delays in treatment. A Population-Based Study of Individually Linked Data from the National Cancer Waiting Times Monitoring Dataset in England, 2009-2013. Time to get a second opinion. Breast self-exam, or regularly examining your breasts on your own, can be an important way to... Ductal carcinoma in situ (DCIS) is non-invasive breast cancer.
Ideally, it would seem that chemotherapy should be started if at all possible within 30 days of surgery, especially for those who have high risk tumors.
We can thus reassure anxious patients who want their surgery tomorrow while at the same time tell patients balking at surgery or chemotherapy how long they can safely wait before the delay starts adversely affecting their chances of survival. The average wait time until surgery has actually been increasing, with the average delay being 21 days in 1998, 31 days in 2003, and 41 days in 2008. Raphael, M., Biagi, J., Kong, W., et al. The thought was that perhaps hurdles related to prior authorizations and navigating the health system might be the reason. They found that for each 30-day interval of delay, survival rates decreased for people with stage I and stage II breast cancer. 2013. How Is Lung Cancer Treated in Older Adults? Let's look at studies of overall survival as well as special groups. Create a profile for better recommendations. Breastcancer.org 120 East Lancaster Avenue, Suite 201 Ardmore, PA 19003
While the reasons weren't certain, it was thought that perhaps those who were insured lost precious time going through prior authorization procedures for diagnostic tests and treatment. Exactly. Although we are discussing treatment delays, let's begin with a few reasons why waiting a few days or weeks may be beneficial. This is by no means a new finding; disparities in health care of this sort have been documented in many previous studies. However, the fact that we observed consistent results in our OS and BCSS [breast cancer specific survival] risk estimates makes this scenario unlikely.
Everyone is different when it comes to the level of anxiety experienced. But these studies strongly suggest that it also makes sense to have surgery within 30 days of diagnosis and to start chemotherapy within 90 days of surgery, especially if you’ve been diagnosed with stage I or stage II triple-negative disease. In the NCDB cohort, delay in surgery was associated with decreased overall survival for stage I (HR, 1.16; 95% CI, 1.12-1.21; P < .001) and stage II disease (HR, 1.09; 95% CI, 1.05-1.13; P < .001) but not stage III (HR, 1.01; 95% CI, 0.96-1.07; P = .64). In the SEER-Medicare cohort, for each increasing interval, the hazard ratio (HR) was 1.09. But, again, it’s unethical to do a randomized trial studying a question like this. © 2020 Breastcancer.org - All rights reserved. The effect of delayed TTC administration has been evaluated retrospectively with contradictory results. 160(1):17-28. From the National Cancer Data Base, the researchers looked at the records of 115,790 people age 18 or older who were diagnosed with nonmetastatic, noninflammatory breast cancer between 2003 and 2005: Overall, after the first 30 days after diagnosis, each 30-day delay in surgery was associated with a 10% decrease in survival. Some people wonder if they can wait until an upcoming vacation to have surgery, or until their children are back in school. The optimal time between diagnosis and surgery can also be looked at from the standpoint of tumor growth, although the doubling rate (how long a breast cancer takes to double in size) varies between different tumors. Our findings suggest that among these specific patient subgroups, every effort should be made to avoid delayed adjuvant chemotherapy initiation. Most patients with breast cancer start adjuvant chemotherapy within 30 to 40 days of surgery. Ask your doctor or nurse for a patient navigator recommendation. By using Verywell Health, you accept our, Delay in Surgery and Tumor Growth: HER2 and Triple Negative Tumors, Time to Treatment With Metastatic Breast Cancer, What Happens When Breast Cancer Spreads to the Brain. It seems only yesterday that Steve Novella approached me to ask me to be a contributor. Some have looked at averages of all people, whereas others have separated out people based on age, tumor type, and receptor status. In a recent study, we reported that a delay of 61 or more days of adjuvant chemotherapy administration was associated with adverse outcomes among patients with stage II and III breast cancer and also among patients with triple-negative and human epidermal growth factor receptor 2 (ERBB2, formerly HER2 or HER2/neu)-positive tumors. Getting a second opinion is almost always a good idea. 84 percent among those who had surgery within two weeks, 83 percent among those who had surgery two to four weeks after diagnosis, 78 percent among those who had surgery more than six weeks after diagnosis. 148(6):516-523. With some procedures, prior authorization is needed before scheduling can take place. Similar comments apply to the time-to-surgery study, based on the strengths and weaknesses of each database used. Breastcancer.org’s EIN is 23-3082851. DOI: 10.1245/s10434-018-6615-2. In the study looking at when women had surgery, the researchers looked at medical records in two databases: From the SEER database, the researchers looked at the records of 94,544 people age 66 or older who were diagnosed with primary stage I to stage III breast cancer from 1992 to 2009: Overall, after the first 30 days after diagnosis, each 30-day delay in surgery was associated with a 9% decrease in survival. Those who are feeling anxious should probably consider having surgery earlier rather than later. Smith, E., Ziogas, A., and H. Anton-Culver. The period of time between surgery and chemotherapy depends somewhat on how well someone does with surgery since the surgical site needs to be relatively well-healed before chemotherapy begins. Studies have found that the times when women (and men) are most prone to anxiety are when waiting for biopsy results, and when waiting for treatment to begin. "Administration of chemotherapy within this time frame is feasible in clinical practice under most clinical scenarios, and as medical oncologists, we should make every effort not to delay the initiation of adjuvant chemotherapy.". In addition, we acknowledge that the potential determinants of chemotherapy initiation include the recommendation of the medical oncologist and the entire multidisciplinary team. Some other studies have not found a difference when chemotherapy was delayed more than four weeks but did see lower survival with longer delays. There are times when it can be challenging to schedule your surgery promptly after diagnosis. This is similar to what Bleicher et al found with respect to time-to-surgery, namely that the proportion of patients with black race or Hispanic ethnicity increased with each interval delay. Because I’m a surgeon I’ll take a look at Bleicher et al first. Delaying for a lengthy period of time can be dangerous, with studies finding that those who delay over six months are twice as likely to die from the disease. Triple-negative breast cancer is estrogen-receptor-negative, progesterone-receptor-negative, and HER2-negative. In the community, you may need to do most of the legwork yourself.
This study didn’t use the SEER database or NCDB. For most people, treatment for early-stage disease is aggressive, with the goal to reduce the risk of recurrence. Don’t let any obstacles get in the way of your treatment! Read our, Medically reviewed by Douglas A. Nelson, MD, Verywell Health uses cookies to provide you with a great user experience. This worse survival was statistically significant for women diagnosed with stage I and stage II disease. Instead it examined a total of 24,843 patients from the California Cancer Registry diagnosed with stage I to III breast cancer between January 1, 2005 and December 31, 2010 treated with adjuvant chemotherapy. A patient navigator can help you understand and move through the health care and insurance systems. The added risk of death from all causes for each interval increase in time to surgery was 10% (HR, 1.10; 95% CI, 1.07-1.13; P < .001). 2016. For example, some studies have looked at the time between a definitive diagnosis and surgery, and others have looked at the time between the onset of symptoms (such as a lump) and the time of surgery. Someone at your doctor’s office may be able to give you a list of organizations that offer financial assistance for breast cancer treatments and care, as well as local organizations that offer financial assistance for your practical needs, such as transportation, food, and child care. In this study, the average wait time between diagnosis and surgery was 31 days (with a range of 8 to 78 days). A 2016 study, though it didn't look at survival, did evaluate the growth rate of breast cancers during wait time for surgery by ultrasound measurements.
Doctors recommend starting treatment as soon as possible after breast cancer is diagnosed. If you’ve been diagnosed with breast cancer, it makes sense to take the time to do some research to make sure your diagnosis is correct and your treatment plan makes sense. Published on December 28, 2015 at 4:26 AM.
The difference in survival was highest in women diagnosed with stage I and stage II disease. This Doctor Discussion Guide has been sent to {{form.email}}. DOI: 10.1200/jco.2013.49.7693.