Abstract
Purpose
To analyse any delays in breast cancer diagnosis and surgical treatment, influence of clinical and biological factors and influence of delays on survival.
Methods/patients
A descriptive, observational, and retrospective study was conducted between 2006 and 2016 on stages I–III breast cancer patients. This is a retrospective review of health records to collect data on delays, patients’ clinical data, biological features of the tumour and information on treatment. Mortality data from the National Death Index.
Results
In 493 evaluable patients, the median of days from the first symptom to mammography, biopsy, and surgery was 41, 57, and 92, respectively. The median of days from screening mammography to biopsy and surgery was 10 and 51, respectively. From biopsy to surgery, the median was 34 days in every case. Over the last 5 years, an increase in biopsy–surgery delay has been observed (p = 0.0001). Tumour stages I and II vs. stage III (RR 1.74. 95% CI 1.08–2.80, p = 0.027), diagnosis in screening (RR 0.66. 95% CI 0.45–0.96, p = 0.030), and use of magnetic resonance imaging (RR 2.08. 95 CI 1.21–3.56, p = 0.008) condition a greater biopsy–surgery delay. No influence of delays on survival has been identified.
Conclusions
Delays in diagnosis and surgery in the case of women diagnosed on the basis of symptoms may be improved. There is a temporary tendency to a greater delay in surgery. Some clinical and biological factors must be taken into account to optimise delays. Survival results are not adversely affected by delays.
Similar content being viewed by others
References
Waks AG, King TA, Winer EP. Timeliness in breast cancer treatment—the sooner, the better. JAMA Oncol. 2016;2(3):302–4. https://doi.org/10.1001/jamaoncol.2015.4506.
Goldie JH, Coldman AJ. A mathematic model for relating the drug sensitivity of tumors to their spontaneous mutation rate. Cancer Treat Rep. 1979;63(11):1727–33.
Harding FA, McArthur JG, Gross JA, Raulet DH, Allison JP. CD28-mediated signalling co-stimulates murine T cells and prevents induction of anergy in T-cell clones. Nature. 1992;356(6370):607–9.
Halsted WS. The results of radical operations for the cure of carcinoma of the breast. Ann Surg. 1907;46(1):1–19.
Richards MA, Westcombe AM, Love SB, Littlejohns P, Ramírez AJ. Influence of delay on survival in patients with breast cancer: a systematic review. Lancet. 1999;353:1119–26.
Wagner JL, Warneke CL, Mittendorf EA, Bedrosian I, Babiera GV, Kuerer HM, et al. Delays in primary surgical treatment are not associated with significant tumor size progression in breast cancer patients. Ann Surg. 2011;254:119–24.
Brazda A, Estroff J, Euhus D, Leitch AM, Huth J, Andrews V, et al. Delays in time to treatment and survival impact in breast cancer. Ann Surg Oncol. 2010;17:291–6.
Bilimoria KY, Ko CY, Tomlinson JS, Stewart AK, Talamonti MS, Hynes DL, et al. Wait times for cancer surgery in the United States: trends and predictors of delays. Ann Surg. 2011;253:779–85.
DeSantis CE, Fedewa SA, Goding Sauer A, Kramer JL, Smith RA, Jemal A. Breast cancer statistics, 2015: convergence of incidence rates between black and white women. CA Cancer J Clin. 2016;66(1):31–42.
Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5(6):649–55.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis. 1987;40(5):373–83.
Hudis CA, Barlow WE, Constantino JP, Gray RJ, Pritchard KI, Chapman JAW, et al. Proposal for standardized definitions for efficacy end points in adjuvant breast cancer trials: The STEEP system. J Clin Oncol. 2007;25(15):2127–32.
Richardson LC, Royalty J, Howe W, Helsel W, Kammerer W, Benard VB. Timeliness of breast cancer diagnosis and initiation of treatment in the National Breast and Cervical Cancer Early Detection Program, 1996–2005. Am J Public Health. 2010;100:1769–76.
Molinie F, Leux C, Delafosse P, Ayrault-Piault S, Arveux P, Woronoff AS, et al. Waiting time disparities in breast cancer diagnosis and treatment: a population-based study in France. Breast. 2013;22:810–6.
Norsaadah B, Rampal KG, Rahmah MA, Naing NN, Biswal BM. Diagnosis delay of breast cancer and its associated factors in Malaysian women. BMC Cancer. 2011;11:141.
Unger-Saldaña K, Miranda A, Zarco-Espinosa G, Mainero-Ratchelous F, Bargalló-Rocha E, Lázaro-León JM. Health system delay and its effect on clinical stage of breast cancer: multicenter study. Cancer. 2015;121:2198–206.
Barros AF, Uemura G, Macedo JL. Interval for access to treatment for breast cancer in the Federal District, Brazil. Rev Bras Ginecol Obstet. 2013;35:458–63.
Arnaout A, Catley C, Booth CM, McInnes M, Graham I, Kumar V, et al. Use of preoperative magnetic resonance imaging for breast cancer: a Canadian population-based study. JAMA Oncol. 2015;1(9):1238–50. https://doi.org/10.1001/jamaoncol.2015.3018.
Turnbull L, Brown S, Harvey I, Olivier C, Drew P, Napp V, et al. Comparative effectiveness of MRI in breast cancer (COMICE) trial: a randomised controlled trial. Lancet. 2010;375(9714):563–71. https://doi.org/10.1016/S0140-6736(09)62070-5.
Sainsbury R, Johnston C, Haward B. Effect on survival of delays in referral of patients with breast-cancer symptoms: a retrospective analysis. Lancet. 1999;353:1132–5.
Arndt V, Sturmer T, Stegmaier C, Ziegler H, Becker A, Brenner H. Provider delay among patients with breast cancer in Germany: a population-based study. J Clin Oncol. 2003;21:1440–6.
Chiarelli AM, Muradali D, Blackmore KM, Smith CR, Mirea L, Majpruz V, et al. Evaluating wait times from screening to breast cancer diagnosis among women undergoing organised assessment vs usual care. Br J Cancer. 2017;116:1254–63. https://doi.org/10.1038/bjc.2017.87.
Olivotto IA, Gomi A, Bancej C, Brisson J, Tonita J, Kan L, et al. Influence of delay to diagnosis on prognostic indicators of screen-detected breast carcinoma. Cancer. 2002;94:2143–50. https://doi.org/10.1002/cncr.10453.
Lee SH, Kim YS, Han W, Ryu HS, Chang JM, Cho N, et al. Tumor growth rate of invasive breast cancers during wait times for surgery assessed by ultrasonography. Medicine (Baltimore). 2016;95(37):e4874. https://doi.org/10.1097/MD.0000000000004874.
Bleicher RJ, Ruth K, Sigurdson ER, Beck JR, Ross E, Wong Y-N, et al. Time to surgery and breast cancer survival in the United States. JAMA Oncol. 2016;2(3):330–9.
Thorne SE, Harris SR, Hislop TG, Vestrup JA. The experience of waiting for diagnosis after an abnormal mammogram. Breast J. 1999;5:42–51.
Funding
This research did not receive any specific Grant from funding agencies in the public, commercial, or not-for-profit sectors.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
The required favourable report of the institution’s Research Ethics Committee was requested and obtained.
Informed consent
Since it is a retrospective study based on the data contained in the medical histories and there has been no intervention or risks to patients, their informed consent was not necessary.
Rights and permissions
About this article
Cite this article
Baena-Cañada, J.M., Rodríguez-Pérez, L., Gámez-Casado, S. et al. Evaluation of waiting times for breast cancer diagnosis and surgical treatment. Clin Transl Oncol 20, 1345–1352 (2018). https://doi.org/10.1007/s12094-018-1867-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12094-018-1867-7