title: Effect of interval to definitive breast surgery on clinical presentation and survival in early-stage invasive breast cancer.
abstract: OBJECTIVE
  To examine the effect of clinical presentation and interval to breast surgery on local recurrence and survival in early-stage breast cancer.
  
  
  METHODS
  The data from 397 patients with Stage T1-T2N0 breast carcinoma treated with conservative surgery and breast radiotherapy between 1985 and 1992 were reviewed at the London Regional Cancer Program. The clinical presentation consisted of a mammogram finding or a palpable lump. The intervals from clinical presentation to definitive breast surgery used for analysis were 0-4, >4-12, and >12 weeks. The Kaplan-Meier estimates of the time to local recurrence, disease-free survival, and cause-specific survival were determined for the three groups. Cox regression analysis was used to evaluate the effect of clinical presentation and interval to definitive surgery on survival.
  
  
  RESULTS
  The median follow-up was 11.2 years. No statistically significant difference was found in local recurrence as a function of the interval to definitive surgery (p = .424). A significant difference was noted in disease-free survival (p = .040) and cause-specific survival (p = .006) with an interval of >12 weeks to definitive breast surgery. However, the interval to definitive surgery was dependent on the presentation for cause-specific survival, with a substantial effect for patients with a mammographic presentation and a negligible effect for patients with a lump presentation (interaction p = .041).
  
  
  CONCLUSIONS
  The results of this study suggest that an interval of >12 weeks to breast surgery might be associated with decreased survival for patients with a mammographic presentation, but it appeared to have no effect on survival for patients presenting with a palpable breast lump.
authors.affiliation: Department of Radiation Oncology, London Regional Cancer Program, 790 Commissioners Road East, London, Ontario, Canada. olga.vujovic@lhsc.on.ca
authors.forename: Olga
authors.initials: O
authors.lastname: Vujovic
authors.forename: Edward
authors.initials: E
authors.lastname: Yu
authors.forename: Anil
authors.initials: A
authors.lastname: Cherian
authors.forename: Francisco
authors.initials: F
authors.lastname: Perera
authors.forename: A Rashid
authors.initials: AR
authors.lastname: Dar
authors.forename: Larry
authors.initials: L
authors.lastname: Stitt
authors.forename: A
authors.initials: A
authors.lastname: Hammond
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008327:Mammography; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D009367:Neoplasm Staging; D010173:Palpation; D011879:Radiotherapy Dosage; D012044:Regression Analysis; D012189:Retrospective Studies; D013997:Time Factors