title: Time to Surgery and Breast Cancer Survival in the United States.
abstract: OBJECTIVE
  Time to surgery (TTS) is of concern to patients and clinicians, but controversy surrounds its effect on breast cancer survival. There remains little national data evaluating the association.
  
  
  OBJECTIVE
  To investigate the relationship between the time from diagnosis to breast cancer surgery and survival, using separate analyses of 2 of the largest cancer databases in the United States.
  
  
  METHODS
  Two independent population-based studies were conducted of prospectively collected national data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database and the National Cancer Database (NCDB). The SEER-Medicare cohort included Medicare patients older than 65 years, and the NCDB cohort included patients cared for at Commission on Cancer-accredited facilities throughout the United States. Each analysis assessed overall survival as a function of time between diagnosis and surgery by evaluating 5 intervals (≤30, 31-60, 61-90, 91-120, and 121-180 days) and disease-specific survival at 60-day intervals. All patients were diagnosed with noninflammatory, nonmetastatic, invasive breast cancer and underwent surgery as initial treatment.
  
  
  METHODS
  Overall and disease-specific survival as a function of time between diagnosis and surgery, after adjusting for patient, demographic, and tumor-related factors.
  
  
  RESULTS
  The SEER-Medicare cohort had 94 544 patients 66 years or older diagnosed between 1992 and 2009. With each interval of delay increase, overall survival was lower overall (hazard ratio [HR], 1.09; 95% CI, 1.06-1.13; P < .001), and in patients with stage I (HR, 1.13; 95% CI, 1.08-1.18; P < .001) and stage II disease (HR 1.06; 95% CI, 1.01-1.11; P = .01). Breast cancer-specific mortality increased with each 60-day interval (subdistribution hazard ratio [sHR], 1.26; 95% CI, 1.02-1.54; P = .03). The NCDB study evaluated 115 790 patients 18 years or older diagnosed between 2003 and 2005. The overall mortality HR was 1.10 (95% CI, 1.07-1.13; P < .001) for each increasing interval, significant in stages I (HR, 1.16; 95% CI, 1.12-1.21; P < .001) and II (HR, 1.09; 95% CI, 1.05-1.13; P < .001) only, after adjusting for demographic, tumor, and treatment factors.
  
  
  CONCLUSIONS
  Greater TTS is associated with lower overall and disease-specific survival, and a shortened delay is associated with benefits comparable to some standard therapies. Although time is required for preoperative evaluation and consideration of options such as reconstruction, efforts to reduce TTS should be pursued when possible to enhance survival.
authors.affiliation: Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Bleicher
authors.affiliation: Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Karen
authors.initials: K
authors.lastname: Ruth
authors.affiliation: Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Elin R
authors.initials: ER
authors.lastname: Sigurdson
authors.affiliation: Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: J Robert
authors.initials: JR
authors.lastname: Beck
authors.affiliation: Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Eric
authors.initials: E
authors.lastname: Ross
authors.affiliation: Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Yu-Ning
authors.initials: YN
authors.lastname: Wong
authors.affiliation: Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania5Division of Plastic and Reconstructive Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Sameer A
authors.initials: SA
authors.lastname: Patel
authors.affiliation: Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Marcia
authors.initials: M
authors.lastname: Boraas
authors.affiliation: Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania5Division of Plastic and Reconstructive Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Eric I
authors.initials: EI
authors.lastname: Chang
authors.affiliation: Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania5Division of Plastic and Reconstructive Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Neal S
authors.initials: NS
authors.lastname: Topham
authors.affiliation: Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Egleston
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D018567:Breast Neoplasms, Male / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D018426:SEER Program; D016019:Survival Analysis; D013997:Time Factors; D014481:United States / Q000453:epidemiology