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Title: "First Do No Harm": Significance of Delays from Diagnosis to Surgery in Patients with Non-metastatic Breast Cancer.
Austin Authors: Xu, Jennifer;Bromley, Luke;Chew, Grace ;Yeo, Belinda 
Affiliation: University of Melbourne, Parkville, VIC, 3010, Australia
Medical Oncology
Olivia Newton-John Cancer Research Institute
Royal Melbourne Hospital, 300 Grattan St, Parkville, 3050, Australia
School of Cancer Medicine, La Trobe University, Bundoora, VIC, 3086, Australia
St Vincent's BreastScreen, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia
Department of Surgery, Northern Health, 185 Cooper St, Epping, VIC, 3076, Australia
Issue Date: Nov-2020 2020-08-09
Publication information: World Journal of Surgery 2020; 44(11): 3812-3820
Abstract: The majority of patients with non-metastatic breast cancer will undergo surgery. This involves complex decisions that inevitably increase time from diagnosis to surgery beyond the currently recommended 30 days. This study aims to analyse factors that increase time to surgery and establish whether it is justifiable in the context of improved individualised breast cancer management. A retrospective analysis of all patients at Austin Health surgically managed for non-metastatic invasive breast carcinoma between 2013 and 2019 was conducted. Time to surgery (TTS) was defined as time between informed diagnosis and cancer surgery. The patients were grouped into TTS groups of ≤30 days and >30 days. Kaplan-Meier survival analysis and Cox proportional hazards regression model were used to evaluate the impact of time interval between diagnosis and surgery. Seven hundred and thirty-one patients were included in our TTS analysis, only half of this cohort received surgery within the recommended 30 days. Many of the factors identified to be associated with increased TTS are the key to optimal management. Median follow-up for the cohort was 30 months. Between wait groups of ≤30 and >30 days, there were no significant association found between TTS and survival outcomes for DFS (HR 1.20 95% CI 0.56-2.60) and OS (HR 1.58 95% CI 0.82-3.03). Breast cancer management involves complex factors that significantly increase TTS. Surgery within 30 days of diagnosis is not associated with improved DFS and OS. Outcomes from this study support a revision of current recommendations for TTS in non-metastatic breast cancer care.
DOI: 10.1007/s00268-020-05725-6
ORCID: 0000-0001-8452-0713
PubMed URL: 32776194
Type: Journal Article
Appears in Collections:Journal articles

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