Young women with breast cancer who experience a longer treatment delay time (TDT) have significantly decreased survival time compared with those with a shorter TDT, especially African-American women, those with public or no insurance, and those with low socioeconomic status, according to a report published Online First by JAMA Surgery, a JAMA Network publication.
Breast cancer in women between the ages of 15 and 39 years (adolescents and young adults) accounts for about 5 percent to 6 percent of all breast cancer cases in the United States, and the disease is considered to be more aggressive and have a worse prognosis than in older woman, according to the study background.
Erlyn C. Smith, M.D., of the University of California, Irvine, and colleagues conducted a retrospective case-only study of 8,860 AYA breast cancer cases among adolescents and young adults diagnosed from 1997 to 2006 using the California Cancer Registry database. TDT was defined as the number of weeks between the date of diagnosis and date of definitive treatment.
“The data presented herein provide a unique perspective that can be used to improve the outcome of breast cancer in adolescents and young adult women. Our findings demonstrate that young women with a delay in surgical treatment (>6 weeks) have shorter survival compared with those who had surgery closer to their diagnosis,” the study notes.
According to the results, TDT more than six weeks after diagnosis was significantly different between racial/ethnic groups (Hispanic, 15.3 percent, and African-American, 15.3 percent, compared with non-Hispanic white, 8.1 percent). Women with public or no insurance (17.8 percent) compared with those with private insurance (9.5 percent) and women with low socioeconomic status (17.5 percent) compared with those with high socioeconomic status (7.7 percent) were shown to have TDT more than six weeks.
The five-year survival in women who were treated by surgery and had TDT more than six weeks was 80 percent compared with 90 percent in those with TDT less than two weeks, the results also indicate.
“In conclusion, it is crucial to prevent further physician-related delays before and after the diagnosis of breast cancer is established to maximize the survival of these young women who are in the most productive time of their life,” the study concludes.
Invited Critique: A Strong Argument for Improving Access Without Delay
In an invited critique, Leigh Neumayer, M.D., M.S., of the University of Utah, Salt Lake City, writes: “In the end, in this analysis, we have continued evidence of disparities in health care that lead to decreased survival, whether the disparity is a function of race, income or delays in receiving treatment. We should all work on eliminating these disparities in an effort to improve the health of our nation.”
JAMA Surg. Published online April 24, 2013
JAMA Surg. Published online April 24, 2013. doi:10.1001/jamasurg.2013.1691.