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Invited Critique |

A Strong Argument for Improving Access Without Delay:  Comment on “Delay in Surgical Treatment and Survival After Breast Cancer Diagnosis in Young Women by Race/Ethnicity”

Leigh Neumayer, MD, MS
JAMA Surg. 2013;148(6):524. doi:10.1001/jamasurg.2013.1691.
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In this analysis of a large database, Smith et al1 explore the influence of delay in initiation of treatment for AYA women with breast cancer. Using the California Cancer Registry, Smith et al were able to determine time between diagnosis and initiation of treatment, whether that be surgery or chemotherapy. While difficult to sort out when so much information is presented as in this article, it was only a small subset of patients (those who got surgery only) in which the treatment delay (time from diagnosis to treatment of greater than 6 weeks) was associated in multivariate analysis with decreased survival (adjusted HR, 1.82; 95% CI, 1.21-2.74). Patients who received chemotherapy as part of their treatment were not found to have an independent association between treatment delay and survival. To provide further perspective, adjusted HRs for likelihood of death by cancer stage ranged from 3.14 for stage II to 24.51 for stage IV. Also, interestingly, race was an important predictor of survival for those who received chemotherapy in addition to surgery but not for those who received surgery only.

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