Abstract Context: “Rush to surgery” among patients with worse symptoms, delays related to morbidity, and inclusion of patients with advanced disease have produced a mixed picture of importance of time to treatment to survival of non-small cell lung cancer (NSCLC). Objective: To assess the contribution of diagnosis to first surgery interval to survival among patients diagnosed in the community with early stage NSCLC. Methods: Patients (N=174) diagnosed between 2003 and 2009 and treated at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins were followed for vital status through 2011. Diagnosis to first surgery interval was examined overall; as two segments: referral interval and treatment interval; as short and longer intervals (<22, <31, and <43 days); and as a continuous variable. Our primary end point was survival since first surgery. Results: Cox method hazard analysis revealed older age at diagnosis (OR=1.02 per year 95% confidence intervals:1.00-1.05), stage IIB (OR=2.17, 95% confidence intervals:1.12-4.21), large, >4 cm (OR=3.68, 95% confidence intervals: 1.05-12.93) or unknown tumor size (OR+4.45, 95% confidence intervals: 1.21-16.38), and longer length of diagnosis to first surgery interval predicted worse survival (OR= 1.04 per week delay, 95% confidence intervals: 1.00-1.09). Factors of race, place of residence, marital status, morbidity and insurance coverage were not predictive of survival or interval length. No threshold effect of time to surgery was observed. Conclusions: Surgery is not only the best treatment for early stage NSCLC but it is urgent once a diagnosis is made. Patients benefit from universal consideration of lung cancer as a time sensitive condition that merits rapid response to reduce tumor burden, especially among patients with small tumors. We will need to know more about referral delays encountered by patients, because particularly small tumors found upon low dose computed tomography scan will increase. Referral delay experienced in the community is unduly long (61 days). In addition to patient choices, an unconscious physician bias that lung cancer is untreatable or an inevitable consequence of smoking may be operating. Citation Format: Norma F. Kanarek, Craig M. Hooker, Luckson Mathieu, Hua-Ling Tsai, Charles M. Rudin, James G. Herman, Malcolm V. Brock. Referral delay after community diagnosis of non-small cell lung cancer impairs survival. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B78.