Time-to-surgery and overall survival after breast cancer diagnosis in a universal health system.

Abstract

It is unclear whether time between breast cancer diagnosis and surgery is associated with survival and whether this relationship is affected by access to care. We evaluated the association between time-to-surgery and overall survival among women in the universal-access U.S. Military Health System (MHS). Women aged 18-79 who received surgical treatment for stages I-III breast cancer between 1998 and 2010 were identified in linked cancer registry and administrative databases with follow-up through 2015. Multivariable Cox regression models were used to estimate risk of all-cause death associated with time-to-surgery intervals. The study included 9669 women with 93.1% survival during the study period. The hazards ratios (95% confidence intervals) of all-cause death associated with time-to-surgery were 1.15 (0.93, 1.42) for 0days, 1.00 (reference) for 1-21days, 0.97 (0.78, 1.21) for 22-35days, and 1.30 (1.04, 1.61) for ≥ 36days. The higher risk of mortality associated with time-to-surgery ≥ 36days tended to be consistent when analyzed by surgery type, age at diagnosis, and tumor stage. In the MHS, longer time-to-surgery for breast cancer was associated with poorer overall survival, suggesting the importance of timeliness in receiving surgical treatment for breast cancer in relation to overall survival.