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Impact of delayed treatment in women diagnosed with breast cancer: A population-based study.

ABSTRACT: The impact of timely treatment on breast cancer-specific survival may differ by tumor stage. We aim to study the impact of delayed first treatment on overall survival across different tumor stages. In addition, we studied the impact of delayed adjuvant treatments on survival in patients with invasive nonmetastatic breast cancer who had surgery ?90 days postdiagnosis. This population-based study includes 11 175 breast cancer patients, of whom, 2318 (20.7%) died (median overall survival = 7.9 years). To study the impact of delayed treatment on survival, hazard ratios and corresponding 95% confidence intervals were estimated using Cox proportional-hazards models. The highest proportion of delayed first treatment (>30 days postdiagnosis) was in patients with noninvasive breast cancer (61%), followed by metastatic breast cancer (50%) and invasive nonmetastatic breast cancer (22%). Delayed first treatment (>90 vs ?30 days postdiagnosis) was associated with worse overall survival in patients with invasive nonmetastatic (HR: 2.25, 95% CI 1.55-3.28) and metastatic (HR: 2.09, 95% CI 1.66-2.64) breast cancer. Delayed adjuvant treatment (>90 vs 31-60 days postsurgery) was associated with worse survival in patients with invasive nonmetastatic (HR: 1.50, 95% CI 1.29-1.74). Results for the Cox proportional-hazards models were similar for breast cancer-specific death. A longer time to first treatment (31-90 days postdiagnosis) may be viable for more extensive diagnostic workup and patient-doctor decision-making process, without compromising survival. However, patients' preference and anxiety status need to be considered.

SUBMITTER: Ho PJ

PROVIDER: S-EPMC7131859 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Impact of delayed treatment in women diagnosed with breast cancer: A population-based study.

Ho Peh Joo PJ Cook Alex R AR Binte Mohamed Ri Nur Khaliesah NK Liu Jenny J Li Jingmei J Hartman Mikael M

Cancer medicine 20200213 7

The impact of timely treatment on breast cancer-specific survival may differ by tumor stage. We aim to study the impact of delayed first treatment on overall survival across different tumor stages. In addition, we studied the impact of delayed adjuvant treatments on survival in patients with invasive nonmetastatic breast cancer who had surgery ≤90 days postdiagnosis. This population-based study includes 11 175 breast cancer patients, of whom, 2318 (20.7%) died (median overall survival = 7.9 year ...[more]

PMID: 32053293

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Project description:ObjectivesTo describe long term breast cancer mortality among women with a diagnosis of breast cancer in the past and estimate absolute breast cancer mortality risks for groups of patients with a recent diagnosis.DesignPopulation based observational cohort study.SettingRoutinely collected data from the National Cancer Registration and Analysis Service.ParticipantsAll 512 447 women registered with early invasive breast cancer (involving only breast and possibly axillary nodes) in England during January 1993 to December 2015, with follow-up to December 2020.Main outcome measuresAnnual breast cancer mortality rates and cumulative risks by time since diagnosis, calendar period of diagnosis, and nine characteristics of patients and tumours.ResultsFor women with a diagnosis made within each of the calendar periods 1993-99, 2000-04, 2005-09, and 2010-15, the crude annual breast cancer mortality rate was highest during the five years after diagnosis and then declined. For any given time since diagnosis, crude annual breast cancer mortality rates and risks decreased with increasing calendar period. Crude five year breast cancer mortality risk was 14.4% (95% confidence interval 14.2% to 14.6%) for women with a diagnosis made during 1993-99 and 4.9% (4.8% to 5.0%) for women with a diagnosis made during 2010-15. Adjusted annual breast cancer mortality rates also decreased with increasing calendar period in nearly every patient group, by a factor of about three in oestrogen receptor positive disease and about two in oestrogen receptor negative disease. Considering just the women with a diagnosis made during 2010-15, cumulative five year breast cancer mortality risk varied substantially between women with different characteristics: it was <3% for 62.8% (96 085/153 006) of women but ≥20% for 4.6% (6962/153 006) of women.ConclusionsThese five year breast cancer mortality risks for patients with a recent diagnosis may be used to estimate breast cancer mortality risks for patients today. The prognosis for women with early invasive breast cancer has improved substantially since the 1990s. Most can expect to become long term cancer survivors, although for a few the risk remains appreciable.

Dataset Information

Impact of delayed treatment in women diagnosed with breast cancer: A population-based study.

Publications

Impact of delayed treatment in women diagnosed with breast cancer: A population-based study.

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