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Does Time to Surgery Matter?

When diagnosed with breast cancer, many women describe feeling pressure to “get the cancer out, FAST! ” Others, however, seem slightly annoyed (because of the excellent prognosis for early stage disease) with their diagnosis and would rather not change their plans. They’ll ask, “Can I still go on my cruise?” so that they can enjoy some time before treatment starts. In some cases, doctors have reassured patients that taking a few months to make a decision is perfectly fine, while others have discouraged any delay in surgery and/or treatment.

The issue, referred to as time to surgery (TTS)—that is, the time period between diagnosis of breast cancer and surgery/treatment– has long been shrouded in controversy. However, recent findings suggest that “hurry up” rather than “take it slow” might be the better course.

A study published in December by researchers at Fox Chase Cancer Center in Philadelphia has demonstrated that a longer TTS seems to correlate with lower overall survival. Additionally, researchers reported that reduced TTS appeared to demonstrate benefits similar to those derived from some standard therapies.

Richard J. Bleicher, MD, the primary author of the study and associate professor of surgical oncology and director of the breast fellowship program at Fox Chase Cancer Center, explains, “Nearly every patient who walks through the door asks how soon they will need to schedule surgery or how much time they have before starting treatment.” He said that patients also face the fear of spending time seeking and obtaining multiple opinions on their condition and the best course to take. According to Dr. Bleicher,“The problem has been that there has been no clear data on the effect of an increasing time between diagnosis and surgery for us to answer this question for patients.”

Researchers conducted two independent studies using information from two different national databases of patients diagnosed with non-inflammatory, non-metastatic, invasive breast cancer that underwent surgery as initial treatment. One of the databases included Medicare patients over 65 years old, while the other included patients cared for at Commission on Cancer-accredited facilities throughout the U.S., and each study assessed overall survival (as a function of TTS) by evaluating 5 time intervals ranging between less than 30 to over 180 days.

The study found that, with each increased interval of time, the overall rate of survival decreased for all breast cancer patients, even those with early stage disease. Bleicher commented, “We were surprised by how remarkably consistent the results were. The two analyses suggest to us that the findings are real for the population as a whole, and not something that is tied to a particular subset of the U.S. breast cancer population.”

The critical information provided by the study allows surgeons to address questions frequently asked by patients diagnosed with breast cancer. Bleicher notes, “Now we can advise patients about the down side of getting that third opinion or, for example, taking a 3-week vacation before starting treatment.”

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