title: Wait times for breast surgical operations, 2003-2011: a report from the National Cancer Data Base.
abstract: BACKGROUND
  Few large-scale multicenter studies have examined wait times for breast surgery and no benchmarks exist.
  
  
  METHODS
  Using the National Cancer Data Base, we analyzed time from diagnosis to first surgery for 819,175 non-neoadjuvant AJCC stage 0-III breast cancer patients treated from 2003 to 2011. Chi-square tests and logistic regression models were used to examine factors associated with delays to surgery and adjuvant chemotherapy.
  
  
  RESULTS
  Seventy percent of patients underwent an initial lumpectomy (LP), 22% a mastectomy (MA), and 8% a mastectomy with reconstruction (MR). The median time from diagnosis to first surgery significantly increased by approximately 1 week for all three procedures over the study period. In a multivariate analysis, the following variables were independent predictors of a longer wait time to first surgery: increasing age, black or Hispanic race, Medicaid or no insurance, low-education communities and metropolitan areas, increasing comorbidities, stage 0 and grade 1 disease, academic/research facilities, high-volume facilities, and facilities located in the New England, Mid-Atlantic, and Pacific regions. In 2010-2011, patients who waited >30 days for surgery were 1.36 times more likely (OR = 1.36, 95% CI 1.30-1.43) to experience a delay to adjuvant chemotherapy >60 days compared with patients who were surgically treated within 30 days of diagnosis.
  
  
  CONCLUSIONS
  Facility and socioeconomic factors are most strongly associated with longer wait times for breast operations, and delays to surgery are associated with delays to adjuvant chemotherapy initiation.
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Erik
authors.initials: E
authors.lastname: Liederbach
authors.forename: Mark
authors.initials: M
authors.lastname: Sisco
authors.forename: Chihsiung
authors.initials: C
authors.lastname: Wang
authors.forename: Catherine
authors.initials: C
authors.lastname: Pesce
authors.forename: Susan
authors.initials: S
authors.lastname: Sharpe
authors.forename: David J
authors.initials: DJ
authors.lastname: Winchester
authors.forename: Katharine
authors.initials: K
authors.lastname: Yao
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D015986:Confounding Factors, Epidemiologic; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006801:Humans; D007348:Insurance, Health; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011379:Prognosis; D012017:Referral and Consultation; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D014481:United States