Surgery delays of 90 to 120 days increase breast cancer mortality by 37%Surgery delays after breast cancer diagnosis linked to higher mortality

This meta-analysis evaluated the impact of the time from diagnosis to upfront surgery on outcomes in patients with invasive breast cancer. The study analyzed a large population of 4,921,120 patients. Notably, neoadjuvant cohorts were excluded from the analysis to ensure the focus remained on the timing of upfront surgical intervention. The study design aimed to quantify the risk associated with various durations of delay following a cancer diagnosis.

The primary outcome measured was overall survival. The analysis compared patients who underwent surgery within 30 days of diagnosis against those who experienced varying lengths of delay. The results demonstrated a clear correlation between increasing surgical delays and higher mortality rates. For a delay of 30 to 59 days, the hazard ratio (HR) was 1.08 (p = 0.02). For a delay of 60 to 89 days, the risk of mortality was 12% higher (HR 1.12, p < 0.001). The most significant increase was observed in the 90 to 120 day delay group, which showed a 37% higher risk of mortality (HR 1.37, p = 0.002).

Furthermore, the analysis calculated the risk per 30-day increment of delay. The results showed a 15% increase in mortality risk for every 30-day delay (HR 1.15, p < 0.001). These findings indicate a progressive decline in survival as the time to surgery increases. Secondary outcomes included cancer-specific survival, recurrence, and pathologic upstaging; however, specific numerical data for these secondary outcomes were not reported set.

Regarding safety and tolerability, specific adverse event rates, serious adverse events, or discontinuation rates were not reported. The study's findings were noted as robust after adjustment, and the analysis indicated a low level of publication bias. However, the study notes that these results represent an association between time to surgery and mortality rather than a direct causal link.

These findings contribute to the understanding of surgical timing in breast cancer management. While previous literature may have discussed various factors influencing outcomes, this analysis specifically quantifies the risk associated with the duration of the interval between diagnosis and surgery. The results are robust, but the study acknowledges limitations such as heterogeneous treatment pathways in the prior studies included in the meta-analysis. Additionally, the exclusion of neoadjuvant cohorts was a specific methodological choice to isolate the effect of upfront surgery timing.

Clinically, these results suggest that delays as early as 30 days from diagnosis to upfront surgery are associated with progressively worse survival. This may influence clinical pathways and the prioritization of surgical scheduling for patients with invasive breast cancer. Questions remain regarding the specific factors that contribute to these delays and how specific interventions might mitigate the risks associated with unavoidable delays. The data highlights the importance of timely surgical intervention in the management of invasive breast cancer.