TY - JOUR
T1 - Time-to-surgery and overall survival after breast cancer diagnosis in a universal health system
AU - Eaglehouse, Yvonne L.
AU - Georg, Matthew W.
AU - Shriver, Craig D.
AU - Zhu, Kangmin
N1 - Publisher Copyright:
© 2019, Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2019/11/1
Y1 - 2019/11/1
N2 - Purpose: It is unclear whether time between breast cancer diagnosis and surgery is associated with survival and whether this relationship is affected by access to care. We evaluated the association between time-to-surgery and overall survival among women in the universal-access U.S. Military Health System (MHS). Methods: Women aged 18–79 who received surgical treatment for stages I–III breast cancer between 1998 and 2010 were identified in linked cancer registry and administrative databases with follow-up through 2015. Multivariable Cox regression models were used to estimate risk of all-cause death associated with time-to-surgery intervals. Results: The study included 9669 women with 93.1% survival during the study period. The hazards ratios (95% confidence intervals) of all-cause death associated with time-to-surgery were 1.15 (0.93, 1.42) for 0 days, 1.00 (reference) for 1–21 days, 0.97 (0.78, 1.21) for 22–35 days, and 1.30 (1.04, 1.61) for ≥ 36 days. The higher risk of mortality associated with time-to-surgery ≥ 36 days tended to be consistent when analyzed by surgery type, age at diagnosis, and tumor stage. Conclusions: In the MHS, longer time-to-surgery for breast cancer was associated with poorer overall survival, suggesting the importance of timeliness in receiving surgical treatment for breast cancer in relation to overall survival.
AB - Purpose: It is unclear whether time between breast cancer diagnosis and surgery is associated with survival and whether this relationship is affected by access to care. We evaluated the association between time-to-surgery and overall survival among women in the universal-access U.S. Military Health System (MHS). Methods: Women aged 18–79 who received surgical treatment for stages I–III breast cancer between 1998 and 2010 were identified in linked cancer registry and administrative databases with follow-up through 2015. Multivariable Cox regression models were used to estimate risk of all-cause death associated with time-to-surgery intervals. Results: The study included 9669 women with 93.1% survival during the study period. The hazards ratios (95% confidence intervals) of all-cause death associated with time-to-surgery were 1.15 (0.93, 1.42) for 0 days, 1.00 (reference) for 1–21 days, 0.97 (0.78, 1.21) for 22–35 days, and 1.30 (1.04, 1.61) for ≥ 36 days. The higher risk of mortality associated with time-to-surgery ≥ 36 days tended to be consistent when analyzed by surgery type, age at diagnosis, and tumor stage. Conclusions: In the MHS, longer time-to-surgery for breast cancer was associated with poorer overall survival, suggesting the importance of timeliness in receiving surgical treatment for breast cancer in relation to overall survival.
KW - Breast surgery
KW - Clinical outcomes
KW - Lumpectomy
KW - Mastectomy
KW - Overall survival
UR - http://www.scopus.com/inward/record.url?scp=85071006343&partnerID=8YFLogxK
U2 - 10.1007/s10549-019-05404-8
DO - 10.1007/s10549-019-05404-8
M3 - Article
C2 - 31414244
AN - SCOPUS:85071006343
SN - 0167-6806
VL - 178
SP - 441
EP - 450
JO - Breast Cancer Research and Treatment
JF - Breast Cancer Research and Treatment
IS - 2
ER -