Time interval from diagnosis to treatment of breast cancer at an NCI Comprehensive Cancer Center: Survival and associated demographic factors. Abstract no. A9

Race and age appear to play a role in how quickly a woman newly diagnosed with breast cancer is surgically treated, with a lengthy delay potentially impacting overall survival, report researchers at Johns Hopkins Medical Institutions. Factors such as socioeconomic status and the cumulative effects of a patient’s other illnesses likely contribute to these delays, they say.

Preliminary results of their study of 1,477 patients show that the average interval from breast cancer diagnosis to surgery was six days longer for African-American women than for Caucasian women. Women who were older than age 70 had an average interval of 12 more days than women younger than 40.

The researchers also observed that the women who experienced an interval of more than 60 days between diagnosis and treatment were 1.8 times more likely to have died from any cause when compared to women who had their surgery within 60 days of diagnosis. In this study, the average interval from diagnosis to surgery for all patients was 29 days.

“We think that timely treatment could make difference in patient care,” said Hae Seong Park, M.D., M.P.H., a research coordinator in the Department of Oncology at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins.

As the study is based on the registry data from a single institution, further research is necessary to confirm the findings and to generalize the results. All of the patients had surgery – either a lumpectomy or mastectomy – between 2000 and 2005 at Johns Hopkins Hospital, including those who had a diagnostic biopsy at a different institution.

The researchers found that on average, Caucasian women were treated 28 days from diagnosis, compared to 34 days for African-American women. On average, women younger than 40 were treated within 21 days; patients 40-50 were treated within 28 days; women in their 50s were treated within 31 days; patients 60-70 were treated by 29.5 days after diagnosis; and women over age 70 had an average treatment interval of more than 33 days.

Investigators also looked at the place and year of diagnosis and found that the shortest interval, 24 days on average, occurred during 2000-2001; and the longest was 2002-2003 when the average interval was 34 days. Intervals were less in 2004-2005 (almost 30 days).

There were no significant differences in time to treatment based on the stage of cancer that a woman was diagnosed with, Park says. “Although this is one factor that one might expect a time differential, we did not observe much difference,” she said.

Worrisome to the researchers, however, was the finding that almost 24 percent of patients did not receive adjuvant therapy, such as chemotherapy or hormone therapy following surgery. Preliminary findings suggested that patients who had surgery more than 60 days from diagnosis received adjuvant therapy less frequently. This might be of greater importance, since we know that receiving adjuvant therapy does improve survival, Park says. “Most patients should have received such treatment, but it may be that the cancer registry data did not reflect all of this information,” she said.

The investigators also did not have information on the patients’ insurance status or any other data that could explain some of the time lags. “We plan to review individual patient records and collect more information to confirm what we observed, and perhaps to think about interventions to provide more timely and complete care,” Park said.

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