uu.seUppsala University Publications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Time from breast cancer diagnosis to therapeutic surgery and breast cancer prognosis: A population-based cohort study
Karolinska Inst, Dept Med Epidemiol & Biostat, S-17177 Stockholm, Sweden;Karolinska Univ Hosp, S-17176 Stockholm, Sweden;Karolinska Inst, Radiumhemmet, Dept Oncol, Dept Oncol Pathol,Canc Ctr Karolinska, S-17176 Stockholm, Sweden.
Karolinska Univ Hosp, S-17176 Stockholm, Sweden;Karolinska Inst, Radiumhemmet, Dept Oncol, Dept Oncol Pathol,Canc Ctr Karolinska, S-17176 Stockholm, Sweden.
Karolinska Inst, Dept Med Epidemiol & Biostat, S-17177 Stockholm, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
Show others and affiliations
2018 (English)In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 143, no 5, p. 1093-1104Article in journal (Refereed) Published
Abstract [en]

Theoretically, time from breast cancer diagnosis to therapeutic surgery should affect survival. However, it is unclear whether this holds true in a modern healthcare setting in which breast cancer surgery is carried out within weeks to months of diagnosis. This is a population- and register-based study of all women diagnosed with invasive breast cancer in the Stockholm-Gotland healthcare region in Sweden, 2001-2008, and who were initially operated. Follow-up of vital status ended 2014. 7,017 women were included in analysis. Our main outcome was overall survival. Main analyses were carried out using Cox proportional hazards models. We adjusted for likely confounders and stratified on mode of detection, tumor size and lymph node metastasis. We found that a longer interval between date of morphological diagnosis and therapeutic surgery was associated with a poorer prognosis. Assuming a linear association, the hazard rate of death from all causes increased by 1.011 (95% CI 1.006-1.017) per day. Comparing, for example, surgery 6 weeks after diagnosis to surgery 3 weeks after diagnosis, thereby confers a 1.26-fold increased hazard rate. The increase in hazard rate associated with surgical delay was strongest in women with largest tumors. Whilst there was a clear association between delays and survival in women without lymph node metastasis, the association may be attenuated in subgroups with increasing number of lymph node metastases. We found no evidence of an interaction between time to surgery and mode of detection. In conclusion, unwarranted delays to primary treatment of breast cancer should be avoided. What's new? Theoretically, an increase in the interval between breast-cancer diagnosis and therapeutic surgery should affect survival, but it is uncertain whether that holds true in a modern healthcare setting. In this prospective study, the authors found that even fairly short delays (on the order of days or weeks) from diagnosis to surgery are associated with decreased survival. These results suggest that the time between diagnosis and therapeutic surgery should be kept as short as possible without hampering diagnostic work-up and preoperative patient optimization.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018. Vol. 143, no 5, p. 1093-1104
Keywords [en]
breast cancer, surgery, time factors, survival, cancer epidemiology
National Category
Cancer and Oncology Surgery
Identifiers
URN: urn:nbn:se:uu:diva-362024DOI: 10.1002/ijc.31411ISI: 000440140100013PubMedID: 29603736OAI: oai:DiVA.org:uu-362024DiVA, id: diva2:1256645
Funder
Knut and Alice Wallenberg FoundationSwedish Research CouncilForte, Swedish Research Council for Health, Working Life and WelfareSwedish Cancer SocietyStockholm County CouncilThe Karolinska Institutet's Research FoundationAvailable from: 2018-10-17 Created: 2018-10-17 Last updated: 2018-11-12Bibliographically approved

Open Access in DiVA

No full text in DiVA

Other links

Publisher's full textPubMed

Authority records BETA

Wärnberg, Fredrik

Search in DiVA

By author/editor
Wärnberg, Fredrik
By organisation
Endocrine Surgery
In the same journal
International Journal of Cancer
Cancer and OncologySurgery

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 10 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf