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Time-to-surgery and overall survival after breast cancer diagnosis in a universal health system

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

It is unclear whether time between breast cancer diagnosis and surgery is associated with survival and whether this relationship is affected by access to care. We evaluated the association between time-to-surgery and overall survival among women in the universal-access U.S. Military Health System (MHS).

Methods

Women aged 18–79 who received surgical treatment for stages I–III breast cancer between 1998 and 2010 were identified in linked cancer registry and administrative databases with follow-up through 2015. Multivariable Cox regression models were used to estimate risk of all-cause death associated with time-to-surgery intervals.

Results

The study included 9669 women with 93.1% survival during the study period. The hazards ratios (95% confidence intervals) of all-cause death associated with time-to-surgery were 1.15 (0.93, 1.42) for 0 days, 1.00 (reference) for 1–21 days, 0.97 (0.78, 1.21) for 22–35 days, and 1.30 (1.04, 1.61) for ≥ 36 days. The higher risk of mortality associated with time-to-surgery ≥ 36 days tended to be consistent when analyzed by surgery type, age at diagnosis, and tumor stage.

Conclusions

In the MHS, longer time-to-surgery for breast cancer was associated with poorer overall survival, suggesting the importance of timeliness in receiving surgical treatment for breast cancer in relation to overall survival.

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Data availability

The data that support the findings of this study are not publicly available due to the sensitive nature of the data and presence of protected health information (PHI). The Department of Defense Central Cancer Registry (CCR) data may be requested from the Joint Pathology Center; and the Military Health System Data Repository (MDR) data may be requested from the Defense Health Agency. Restrictions apply to the access and use of these data.

Abbreviations

CCR:

Central Cancer Registry

CI:

Confidence interval

CPT:

Current Procedural Terminology

ER:

Estrogen receptor

FORDS:

Facility Oncology Registry Data Standards

HCPCS:

Healthcare Common Procedure Coding System

HR:

Hazards ratio

ICD:

International Classification of Diseases

MDR:

Military Health System Data Repository

MHS:

Military Health System

PR:

Progesterone receptor

SEER:

Surveillance, Epidemiology, and End Results Program

TTS:

Time-to-surgery

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Acknowledgements

The authors thank the Joint Pathology Center and Defense Health Agency for providing the data used in this study.

Disclaimer

The contents of this publication are the sole responsibility of the authors and do not reflect the views, assertions, opinions or policies of the Uniformed Services University of the Health Sciences (USUHS), the Department of Defense (DoD), or the Departments of the Army, Navy, or Air Force, or any other agency of the U.S. Government, or the Henry M. Jackson Foundation (HJF). Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government.

Funding

This project was supported by the Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center under the auspices of the Henry M. Jackson Foundation for the Advancement of Military Medicine.

Author information

Authors and Affiliations

  1. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Yvonne L. Eaglehouse, Matthew W. Georg, Craig D. Shriver & Kangmin Zhu

  2. Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Yvonne L. Eaglehouse & Craig D. Shriver

  3. Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA

    Yvonne L. Eaglehouse, Matthew W. Georg & Kangmin Zhu

  4. Walter Reed National Military Medical Center, Bethesda, MD, USA

    Craig D. Shriver

  5. Department of Preventive Medicine and Biostatistics; F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA

    Kangmin Zhu

  6. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, 6720A Rockledge Drive, Suite 310, Bethesda, MD, 20817, USA

    Kangmin Zhu

Authors
  1. Yvonne L. Eaglehouse
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Corresponding author

Correspondence to Kangmin Zhu.

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The authors declare that they have no conflict of interest.

Ethical approval

The data linkage project was reviewed and approved by the institutional review boards of the Walter Reed National Military Medical Center and the Defense Health Agency for compliance with ethical standards. All study activities were conducted in accordance with the ethical standards of the institutional review boards and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. It was determined by the institutional review boards that formal consent was not required for this type of study.

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Eaglehouse, Y.L., Georg, M.W., Shriver, C.D. et al. Time-to-surgery and overall survival after breast cancer diagnosis in a universal health system. Breast Cancer Res Treat 178, 441–450 (2019). https://doi.org/10.1007/s10549-019-05404-8

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  • DOI: https://doi.org/10.1007/s10549-019-05404-8

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