title: Timing of Breast Cancer Surgery-How Much Does It Matter?
abstract: Timing of surgical resection after breast cancer diagnosis is dependent on a variety of factors. Lengthy delays may lead to progression; however, the impact of modest delays is less clear. The aim of this study was to evaluate the impact of surgical timing on outcomes, including disease-free survival (DFS) and nodal status (NS). The cancer registry from one academic cancer hospital was retrospectively reviewed. Time from initial biopsy to surgical resection was calculated for patients with ductal carcinoma in situ (DCIS) and stage 1 and 2 invasive carcinomas. Early (0-21 days), intermediate (22-42 days), and late (43-63 days) surgery groups were evaluated for differences in NS and DFS for each cancer stage separately. A total of 3,932 patients were identified for analysis. There were no differences in DFS noted for DCIS. For stage 1, early surgery (ES) was associated with worse DFS compared to intermediate surgery (IS) (p = 0.025). There were no significant differences between ES and late surgery (LS) (p = 0.700) or IS and LS (p = 0.065). In stage II cancers, there was a significant difference in DFS in ES compared to IS (p < 0.001) and LS (p = 0.009). There was no significant difference between IS and LS (p = 0.478). Patients were more likely to undergo immediate reconstruction (p < 0.0001 for all stages) in later time-to-surgery groups, while patients in earlier groups were more likely to undergo breast conserving surgery. There was also no significant difference in NS at time of surgery in clinical stage 1 (p = 0.321) or stage 2 disease (p = 0.571). Delays of up to 60 days were not associated with worse outcomes. This study should reassure patients and surgeons that modest delays do not adversely affect breast cancer outcomes. This allows patients time to consider treatment and reconstruction options.
authors.affiliation: Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: Sara A
authors.initials: SA
authors.lastname: Mansfield
authors.affiliation: Center for Biostatistics, The Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Abdel-Rasoul
authors.affiliation: Division of Surgical Oncology, The Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: Alicia M
authors.initials: AM
authors.lastname: Terando
authors.affiliation: Division of Surgical Oncology, The Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: Doreen M
authors.initials: DM
authors.lastname: Agnese
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000401:mortality / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D014850:Waiting Lists
keywords: breast cancer; surgery; timing