Delay in Surgical Treatment and Survival After Breast Cancer Diagnosis in Young Women by Race/Ethnicity | Adolescent Medicine | JAMA Surgery | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 18.204.227.34. Please contact the publisher to request reinstatement.
1.
American Cancer Society.  Breast Cancer Facts and Figures, 2011-2012. Atlanta, GA: American Cancer Society Inc; 2011
2.
Bland KI, Menck HR, Scott-Conner CE, Morrow M, Winchester DJ, Winchester DP. The National Cancer Data Base 10-year survey of breast carcinoma treatment at hospitals in the United States.  Cancer. 1998;83(6):1262-12739740094PubMedGoogle ScholarCrossref
3.
Bonnier P, Romain S, Charpin C,  et al.  Age as a prognostic factor in breast cancer: relationship to pathologic and biologic features.  Int J Cancer. 1995;62(2):138-1447622286PubMedGoogle ScholarCrossref
4.
Gajdos C, Tartter PI, Bleiweiss IJ, Bodian C, Brower ST. Stage 0 to stage III breast cancer in young women.  J Am Coll Surg. 2000;190(5):523-52910801018PubMedGoogle ScholarCrossref
5.
Fisher CJ, Egan MK, Smith P, Wicks K, Millis RR, Fentiman IS. Histopathology of breast cancer in relation to age.  Br J Cancer. 1997;75(4):593-5969052416PubMedGoogle ScholarCrossref
6.
Bleyer A, O’Leary M, Barr R, Ries LAG. Cancer Epidemiology in Older Adolescents and Young Adults 15 to 29 Years of Age, Including SEER Incidence and Survival: 1975-2000Bethesda, MD: National Cancer Institute; 2006:116. NIH Pub. No. 06-5767
7.
Cancer Surveillance Section.  Cancer Reporting in California: Standards for Automated Reporting. California Cancer Reporting System Standards. Vol 2. Sacramento: California Department of Health Services, Cancer Surveillance Section; 1997
8.
Cancer Surveillance Section.  Cancer Reporting in California: Data Standard for Localized/Regional Registries and California Cancer Registry. California Cancer Reporting System Standards. Vol 3. Sacramento: California Department of Health Services, Cancer Surveillance Section; 1997
9.
Cancer Surveillance Section.  Abstract and Coding Procedures for Hospitals. California Cancer Reporting System Standards. Vol 1. Sacramento: California Department of Health Services, Cancer Surveillance Section; 1997
10.
Cancer Surveillance Section.  Reporting Procedures for Physicians. California Cancer Reporting System Standards. Vol 4. Sacramento: California Department of Health Services, Cancer Surveillance Section; 1997
11.
 How complete are California Cancer Registry Data? California Cancer Registry website. http://www.ccrcal.org/Inside_CCR/FAQ.shtml. Accessed March 22, 2012
12.
Flitz A, Percy C, Jack A. International Classification of Diseases for Oncology. 3rd ed. Geneva, Switzerland: World Health Organization; 2000
13.
Yost K, Perkins C, Cohen R, Morris C, Wright W. Socioeconomic status and breast cancer incidence in California for different race/ethnic groups.  Cancer Causes Control. 2001;12(8):703-71111562110PubMedGoogle ScholarCrossref
14.
Sariego J. Breast cancer in the young patient.  Am Surg. 2010;76(12):1397-140021265355PubMedGoogle Scholar
15.
Shavers VL, Harlan LC, Stevens JL. Racial/ethnic variation in clinical presentation, treatment, and survival among breast cancer patients under age 35.  Cancer. 2003;97(1):134-14712491515PubMedGoogle ScholarCrossref
16.
Bradley CJ, Given CW, Roberts C. Race, socioeconomic status, and breast cancer treatment and survival.  J Natl Cancer Inst. 2002;94(7):490-49611929949PubMedGoogle ScholarCrossref
17.
Bleyer A, O’Leary M, Barr R, Ries LAG. Cancer Epidemiology in Older Adolescents and Young Adults 15 to 29 Years of Age, Including SEER Incidence and Survival: 1975-2000Bethesda, MD: National Cancer Institute; 2006:114. NIH Pub. No. 06-5767
18.
Fedewa SA, Edge SB, Stewart AK, Halpern MT, Marlow NM, Ward EM. Race and ethnicity are associated with delays in breast cancer treatment (2003-2006).  J Health Care Poor Underserved. 2011;22(1):128-14121317511PubMedGoogle Scholar
19.
Bilimoria KY, Ko CY, Tomlinson JS,  et al.  Wait times for cancer surgery in the United States: trends and predictors of delays.  Ann Surg. 2011;253(4):779-78521475020PubMedGoogle ScholarCrossref
20.
Halpern MT, Bian J, Ward EM, Schrag NM, Chen AY. Insurance status and stage of cancer at diagnosis among women with breast cancer.  Cancer. 2007;110(2):403-41117562557PubMedGoogle ScholarCrossref
21.
Brazda A, Estroff J, Euhus D,  et al.  Delays in time to treatment and survival impact in breast cancer.  Ann Surg Oncol. 2010;17:(suppl 3)  291-29620853049PubMedGoogle ScholarCrossref
22.
Machiavelli M, Leone B, Romero A,  et al.  Relation between delay and survival in 596 patients with breast cancer.  Oncology. 1989;46(2):78-822710480PubMedGoogle ScholarCrossref
23.
Charlson ME. Delay in the treatment of carcinoma of the breast.  Surg Gynecol Obstet. 1985;160(5):393-3993992441PubMedGoogle Scholar
24.
Jung SY, Sereika SM, Linkov F, Brufsky A, Weissfeld JL, Rosenzweig M. The effect of delays in treatment for breast cancer metastasis on survival.  Breast Cancer Res Treat. 2011;130(3):953-96421739101PubMedGoogle ScholarCrossref
25.
Afzelius P, Zedeler K, Sommer H, Mouridsen HT, Blichert-Toft M. Patient's and doctor's delay in primary breast cancer: prognostic implications.  Acta Oncol. 1994;33(4):345-3518018364PubMedGoogle ScholarCrossref
26.
DeSantis C, Jemal A, Ward EM. Disparities in breast cancer prognostic factors by race, insurance status, and education.  Cancer Causes Control. 2010;21(9):1445-145020506039PubMedGoogle ScholarCrossref
Original Article
June 2013

Delay in Surgical Treatment and Survival After Breast Cancer Diagnosis in Young Women by Race/Ethnicity

Author Affiliations

Author Affiliations: Department of Epidemiology (Drs Smith, Ziogas, and Anton-Culver) and Genetic Epidemiology Research Institute (Drs Ziogas and Anton-Culver), University of California, Irvine, and Children's Hospital of Orange County, Orange (Dr Smith).

JAMA Surg. 2013;148(6):516-523. doi:10.1001/jamasurg.2013.1680
Abstract

Importance Breast cancer in women between the ages of 15 and 39 years (adolescents and young adults [AYAs]) constitutes 5% to 6% of all breast cancer cases in the United States. Breast cancer in AYA women has a worse prognosis than in older women. Five-year survival rates are lowest for AYA women, and only a few studies have examined the impact of delay in treatment, race/ethnicity, and other socioeconomic factors on survival in AYA women.

Objective To examine the impact of treatment delay time (TDT), race/ethnicity, socioeconomic status, insurance status, cancer stage, and age on the survival from breast cancer among AYA women.

Design, Setting, and Participants This is a retrospective case-only study of 8860 AYA breast cancer cases diagnosed from 1997 to 2006 using the California Cancer Registry database.

Exposure Treatment delay time was defined as the number of weeks between the date of diagnosis and date of definitive treatment. Kaplan-Meier estimation was used to generate survival curves, and a multivariate Cox proportional hazards regression model was performed to assess the association of TDT with survival while accounting for covariates (age, race/ethnicity, socioeconomic status, insurance status, cancer stage [American Joint Committee on Cancer], tumor markers, and treatment).

Main Outcomes and Measures Five-year survival rates for breast cancer as influenced by host factors, tumor factors, and TDT.

Results Treatment delay time more than 6 weeks after diagnosis was significantly different (P < .001) between racial/ethnic groups (Hispanic, 15.3% and African American, 15.3% compared with non-Hispanic white, 8.1%). Women with public or no insurance (17.8%) compared with those with private insurance (9.5%) and women with low socioeconomic status (17.5%) compared with those with high socioeconomic status (7.7%) were shown to have TDT more than 6 weeks. The 5-year survival in women who were treated by surgery and had TDT more than 6 weeks was 80% compared with 90% (P = .005) in those with TDT less than 2 weeks. In multivariate analysis, longer TDT, estrogen receptor negative status, having public or no insurance, and late cancer stage were significant risk factors for shorter survival.

Conclusions and Relevance Young women with breast cancer with a longer TDT have significantly decreased survival time compared with those with a shorter TDT. This adverse impact on survival was more pronounced in African American women, those with public or no insurance, and those with low SES.

×