School of Medicine

Breast cancer treatment delays linked to decreased survival

April 24, 2013 — Young women and adolescents whose breast cancer treatment is delayed six weeks or more have significantly decreased survival times, according to a study by UC Irvine epidemiologists. This is especially true for African-Americans, Latinas, women with public or no insurance, and those with low socioeconomic status, the study showed.

Their findings appear online in JAMA Surgery, a publication of the Journal of the American Medical Association.

More aggressive cancers

Breast cancer in women between the ages of 15 and 39 years accounts for about 5 percent to 6 percent of all U.S. breast cancer cases, but the disease is generally more aggressive and has a worse prognosis than in older woman, according to the study.

Dr. Erlyn C. Smith, Dr. Argyrios Ziogas and Dr. Hoda Anton-Culver of UC Irvine conducted a 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. Treatment delay time was defined as the number of weeks between the date of diagnosis and date of definitive treatment.

“The data provided a unique perspective that can be used to improve the outcome of breast cancer in adolescents and young adult women," said Anton-Culver, professor and chair of epidemiology and director of the Genetic Epidemiology Research Institute at UC Irvine. "Our findings demonstrate that young women with more than a six-week delay in surgical treatment have shorter survival times compared with those who had surgery closer to their diagnosis.”

Delays linked to race, ethnicity and poverty

Researchers found that surgical or chemotherapy treatment delays of more than six weeks after diagnosis differed significantly among racial, ethnic and socioeconomic groups.

Treatment delays occurred in 15.3 percent of Latinas and 15.3 percent of African-Americans, but only 8.1 percent of non-Hispanic whites. Treatment delays of 17.8 percent occurred among women with public or no insurance compared 9.5 percent of women with private insurance. Delays of more than six weeks were reported in 17.5 percent of women with low socioeconomic status compared to 7.7 percent in women with greater means.

The five-year survival in women who were treated by surgery and had treatment delays of more than six weeks was 80 percent compared with 90 percent in those with treatment times of less than two weeks, the results also indicate. Weighing all factors, the study determined that five-year survival rates were highest for whites (86 percent), followed by Asian Americans (81 percent), Latinas (74 percent) and African Americans (57 percent).

“In conclusion, 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 lives,” Anton-Culver said.