Breast Cancer Study cites risks in delaying treatment

April 30, 2013 at 12:00a.m.

By Karen Kaplan

Los Angeles Times

It stands to reason that the longer a woman waits to start breast-cancer treatment, the worse her prognosis.

A new study of California women puts some hard numbers on the cost of delaying treatment — and finds that Latinas, African-Americans and poor women were most likely to put their recovery at risk by waiting six weeks or more to have surgery or begin chemotherapy.

Researchers from the University of California, Irvine and Children’s Hospital of Orange County focused on breast cancer patients between age 15 and 39. Females in this age group account for only 5 percent to 6 percent of all breast cancer patients, but their cancers are typically more aggressive, and the urgency to begin treatment is increased.

Using data from the California Cancer Registry database, the research team identified 8,860 women who were diagnosed between 1997 and 2006.

Records in the database showed which women began treatment within two weeks of diagnosis and which women waited at least six weeks to get their treatment under way.

Here’s what they found:

Twenty-two percent of women who delayed their treatment for at least six weeks were not alive five years after their diagnosis. That compares with 16 percent of women who began treatment within two weeks of diagnosis and 17 percent of women who got started within two to four weeks.

Nearly 18 percent of women with a low socioeconomic status, or SES, delayed their treatment for at least six weeks, compared with 8 percent of women with a high SES. Perhaps as a result, 28 percent of the low SES women died within five years, compared with 11 percent of the high SES women.

In a related finding, 18 percent of women with no health insurance or who were insured through a public program waited at least six weeks to begin treatment, and 31 percent of them died within five years.

Among women with private health insurance, 10 percent delayed their treatment for at least six weeks, and 14 percent died within five years.

When the researchers considered the race, ethnicity, insurance status and SES of the women all at the same time, they found that the five-year survival rate was lowest for African-American women (57 percent), followed by Latinas (74 percent), Asian Americans (81 percent) and whites (86 percent).

The results were published online last week by the journal JAMA Surgery.

“Surgical delay time was a significant risk factor for reduced survival after breast cancer diagnosis independent of race/ethnicity, cancer state at diagnosis, age, insurance type and SES,” the researchers said.

“It may be difficult for a physician to make arrangements for surgery because of barriers such as a patient’s lack of insurance,” they concluded.

However, an invited critique that was also published by JAMA Surgery said the data were sliced and diced in so many ways that it’s hard to say with great confidence that treatment delay can be singled out as a culprit.

“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,” wrote Dr. Leigh Neumayer of the University of Utah School of Medicine in Salt Lake City.

“We should all work on eliminating these disparities in an effort to improve the health of our nation,” Neumayer added.