Among younger women, a treatment delay longer than 6 weeks was significantly associated with worse 5-year survival compared with those who were treated within 2 weeks or within 2 to 4 weeks (78% versus 84% and 83%, respectively, P=0.005 for both), reported Erlyn C. Smith, MD, of Children's Hospital of Orange County in Orange, Calif., and colleagues.
Such long treatment delays were harder on African Americans and Hispanics, who had 5-year survival rates of 57% and 74%, respectively, compared with 86% in white women (P<0.001 for both), they reported online in the JAMA Surgery.
Similar survival outcomes were seen in young women lacking insurance, compared with women who had private or military insurance (69% versus 82%, P<0.001). Women with low socioeconomic status (SES) compared with those with high socioeconomic status (69% versus 84%, P=0.003) showed poorer outcomes as well, they reported.
Of all breast cancer in females in the U.S., 5% to 6% is seen in 15-to-39-year-olds, the authors said. In those adolescents and young women, breast cancer carries a worse prognosis than in older women; they have the lowest 5-year survival rates among all age groups. But few studies have examined the impact of treatment delay, race and ethnicity, and socioeconomic factors on survival in this cohort, the authors noted.
"After a diagnosis of breast cancer is established, it may be difficult for a physician to make arrangements for surgery because of barriers such as a patient's lack of insurance or pending public insurance due to unemployment," they wrote. "Consequently, although surgical delay time is seen mostly as a physician-related delay, it can be affected by other patient-related factors such as insurance status and SES."
Smith and colleagues conducted the retrospective case-only study of 8,860 breast cancer cases among adolescents and young adults diagnosed from 1997 to 2006 using the California Cancer Registry database.
In multivariate analysis, they found that longer treatment delay time, estrogen receptor-negative status, having public or no insurance, and late cancer stage were significant risk factors for shorter survival.
Women with estrogen receptor-negative tumors had the worst 5-year survival compared with patients with estrogen receptor-positive tumors when stratified by treatment: surgery (hazard ratio 3.14, 95% CI 2.18 to 4.53, P<0.001), neoadjuvant chemotherapy (HR 2.19, 95% CI 1.63 to 2.94, P<0.001), and chemotherapy after surgery (HR 2.26, 95% CI 1.92 to 2.66, P<0.001).
Study limitations included using registry data that might exclude cancer stage and dates of diagnosis and surgery, the authors said. Also, data for pregnant women might be affected by treatment delayed until after childbirth. The authors also noted that, anecdotally, some young women presented to their primary care physicians on numerous occasions prior to being diagnosed with breast cancer.
"It is crucial to prevent further physician-related delays before and after the diagnosis of breast cancer is established to maximize the survival of these young women who are in the most productive time of their life," the authors said.
In an invited critique, Leigh Neumayer, MD, of University of Utah in Salt Lake City, noted that patients who received chemotherapy were not found to have an independent association between treatment delay and survival.
Commenting about the need for timely and appropriate treatment, Jennifer Litton, MD, of the University of Texas MD Anderson Cancer Center, said in an interview: "A lot of things have changed as far as treating young women with breast cancer during these years, such as using tamoxifen, such as using the anti-HER2 agent trastuzumab [Herceptin] ... It's been a real game-changer for a lot of women with HER2 over-expressed cancers."
News Source: www.medpagetoday.com
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