Time to Treatment and Survival in Young Women with Breast Cancer

In 2011, according to the American Cancer Society, there were approximately 203,500 women diagnosed with invasive breast cancer in the United States and nearly 39,500 women died of the disease. Of the 203,500 women with breast cancer, 11,300 were <40 years of age and nearly 1200 women in that age group died of the disease in 2011.

Breast cancer is considered to be more aggressive in adolescents and young adults (AYAs) 15 to 39 years of age and has a worse prognosis than in older women. The 5-year survival rates are lowest for AYA women, due to the aggressive biologic and pathologic characteristics of tumors.

Noting that there have been only a few studies assessing the impact of treatment delay time (TDT) in survival after breast cancer in AYA women, researchers recently conducted a study to examine the impact of TDT as well as race/ethnicity, socioeconomic status (SES), insurance status, cancer stage, and age on survival from breast cancer among this population. They reported study results online in JAMA Surgery [doi:10.1001/jamasurg.2013.1680].

The retrospective case-only study utilized the California Registry database to identify 8860 AYA breast cancer cases diagnosed from 1997 to 2006. The primary outcomes and measures were 5-year survival rates for breast cancer as influenced by host factors, tumor factors, and TDT.

Treatment delay time was defined as the number of weeks between the date of the diagnosis and the date of definitive treatment. Survival curves were generated using Kaplan-Meier estimation, and a multivariate Cox proportional hazards regression model was performed to assess the association of TDT with survival.

Of the 8860 AYA women with breast cancer in the study, 49.8% were non-Hispanic white and 27.7% were Hispanic; 28.3% of the cases were stage I breast cancer and 18.2% were stages III to IV.

Mean TDT for all cases was 2.7 weeks. Among women with TDT >6 weeks, 15.3% were Hispanic and 15.3% were African American (P<.001), and 8.1% were non-Hispanic white. More AYA women with breast cancer with low SES had TDT >6 weeks compared with those with high SES (17.8% vs 7.7%, respectively) (P<.001).

More women with public or no insurance had TDT >6 weeks compared with those with private insurance (17.8% vs 9.5%, respectively) (P<.001). More women with stage III (14.6%) or stage IV (12.7%) breast cancer had a TDT >6 weeks compared with those with stage I breast cancer (9.7%) (P<.001).

In women treated with surgery, the 5-year survival rate for those with TDT >6 weeks was 80% compared with 90% for those with TDT <2 weeks (P=.005).

Multivariate analyses found that longer TDT, estrogen receptor negative status, having public or no insurance, and late cancer stage were all significant risk factors for shorter survival.

Study limitations cited by the authors included using a registry as a data source and the possibility that treatment may have been delayed because the breast cancer diagnosis was made during pregnancy.

In conclusion, the researchers said, “Young women with breast cancer with a longer TDT have significantly decreased survival time compared with those with a shorter TDT. This adverse impact on survival was more pronounced in African-American women, those with public or no insurance, and those with low SES.”