Determinants of therapeutic delays and their impact on axillary node involvement in operable invasive breast cancer (BC) patients (pts)

Abstract

615 Background: International guidelines recommend rapid diagnostic and therapeutic procedures for suspect breast lesions. However, the impact of the interval between screening and treatment (trt) (STI) on the severity of the disease remains unclear. We explored the potential impact of STI on a surrogate of survival, axillary nodal involvement (N+), among 1,000 recently diagnosed BC pts, as well as the causes of potential delays. Methods: We collected complete data of prospectively recorded community BC cases in a single regional cancer center between January 1, 2005, and October 10, 2007. Pts were eligible if they i. had a final diagnosis of invasive BC ii. were operated as first trt for BC, iii. had no history of other previous malignancy within the past 5 year period. Logistic regression analyses (SAS) were used to determine factors predictive of N+ and those influencing intervals between first description of the lesion and first therapeutic surgery (STI). Candidate factors included socio-economic variables (marital status, occupation, county of living, country of birth), personal and familial medical history parameters, as well as BC characteristics. Results: 990 pts met the inclusion criteria and had full data available. Med age: 59 years, BI-RAD ACR3/4/5: 2/41/55%, med pathological tumor size (pT): 16 mm (2–100), N+: 41%, med delay between first description of the lesion and surgery: 67 days. Factors predicting longer STI were: Birad ACR<5 vs 5 (p = 0.0004), not palpable lesion vs palpable (p = 0.01), microcalcifications vs solid lesion (p = 0.0008), presence of important comorbidities (p=.04), single life vs couple (p = 0.001). However, STI had no effect on N+: med STI was 68 days in N- vs 66 days in N+ pts. Factors predictive of N+ were lymphovascular invasion (LVI) (p=.0001) and pT (p = 0.0001), while age, social conditions, screening mode, per-cutaneous biopsy vs FNAC, grade, HR and HER-2 status, had no effect. Among pts with grade III BC, LVI (p = 0.0001) and pT (p = 0.02) were the sole predictors of N+ as well. Conclusions: This study identifies for the first time factors able to negatively influence STI of women with invasive BC. However, longer STI does not appear to influence axillary nodal invasion, even in pts with high grade BC. No significant financial relationships to disclose.