Surgical delay-associated mortality risk varies by subtype in loco-regional breast cancer patients in SEER-Medicare
Abstract Substantial evidence supports that delay of surgery after breast cancer diagnosis is associated with increased mortality risk, leading to the introduction of a new Commission on Cancer quality measure for receipt of surgery within 60 days of diagnosis for non-neoadjuvant patients. Breast ca...
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BMC
2024-12-01
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| Series: | Breast Cancer Research |
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| Online Access: | https://doi.org/10.1186/s13058-024-01949-9 |
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| author | Macall Leslie Salewon Rashmi Pathak William C. Dooley Ronald A. Squires Hallgeir Rui Inna Chervoneva Takemi Tanaka |
| author_facet | Macall Leslie Salewon Rashmi Pathak William C. Dooley Ronald A. Squires Hallgeir Rui Inna Chervoneva Takemi Tanaka |
| author_sort | Macall Leslie Salewon |
| collection | DOAJ |
| description | Abstract Substantial evidence supports that delay of surgery after breast cancer diagnosis is associated with increased mortality risk, leading to the introduction of a new Commission on Cancer quality measure for receipt of surgery within 60 days of diagnosis for non-neoadjuvant patients. Breast cancer subtype is a critical prognostic factor and determines treatment options; however, it remains unknown whether surgical delay-associated breast cancer-specific mortality (BCSM) risk differs by subtype. This retrospective cohort study aimed to assess whether the impact of delayed surgery on survival varies by subtype (hormone [HR] + /HER2 −, HR −/HER2 −, and HER2 +) in patients with loco-regional breast cancer who received surgery as their first treatment between 2010 and 2017 using the SEER-Medicare database. Exposure of this study was continuous time to surgery from diagnostic biopsy (TTS; days) in reference to TTS = 30 days. BCSM were evaluated as flexibly dependent on continuous time (days) to surgery from diagnosis (TTS) using Fine and Gray competing-risk regression models, respectively, by HR status. Inverse propensity score-weighting was adjusted for demographic, clinical, and treatment variables impacting TTS. Adjusted BCSM risk grew with increasing TTS across all subtypes; however, the pattern and extent of the association varied. HR + /HER2 − patients exhibited the most pronounced increase in BCSM risk associated with TTS, with approximately exponential growth after 42 days, with adjusted subdistribution hazard ratios (sHR) of 1.21 (95% CI: 1.06–1.37) at TTS = 60 days, 1.79 (95% CI: 1.40–2.29) at TTS = 90 days, and 2.83 (95% CI: 1.76–4.55) at TTS = 120 days. In contrast, both HER2 + and HR −/HER2 − patients showed slower, approximately linear growth in sHR, although non-significant in HR −HER2 −. |
| format | Article |
| id | doaj-art-5e0fb03483e34cac93b4667d5a071cfa |
| institution | Kabale University |
| issn | 1465-542X |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Breast Cancer Research |
| spelling | doaj-art-5e0fb03483e34cac93b4667d5a071cfa2025-01-05T12:50:39ZengBMCBreast Cancer Research1465-542X2024-12-012611910.1186/s13058-024-01949-9Surgical delay-associated mortality risk varies by subtype in loco-regional breast cancer patients in SEER-MedicareMacall Leslie Salewon0Rashmi Pathak1William C. Dooley2Ronald A. Squires3Hallgeir Rui4Inna Chervoneva5Takemi Tanaka6Stephenson Cancer Center, University of Oklahoma Health Sciences CenterStephenson Cancer Center, University of Oklahoma Health Sciences CenterDepartment of Surgery, School of Medicine, University of Oklahoma Health Sciences CenterDepartment of Surgery, School of Medicine, University of Oklahoma Health Sciences CenterDepartment of Pharmacology, Physiology, and Cancer Biology, Thomas Jefferson UniversityDivision of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson UniversityStephenson Cancer Center, University of Oklahoma Health Sciences CenterAbstract Substantial evidence supports that delay of surgery after breast cancer diagnosis is associated with increased mortality risk, leading to the introduction of a new Commission on Cancer quality measure for receipt of surgery within 60 days of diagnosis for non-neoadjuvant patients. Breast cancer subtype is a critical prognostic factor and determines treatment options; however, it remains unknown whether surgical delay-associated breast cancer-specific mortality (BCSM) risk differs by subtype. This retrospective cohort study aimed to assess whether the impact of delayed surgery on survival varies by subtype (hormone [HR] + /HER2 −, HR −/HER2 −, and HER2 +) in patients with loco-regional breast cancer who received surgery as their first treatment between 2010 and 2017 using the SEER-Medicare database. Exposure of this study was continuous time to surgery from diagnostic biopsy (TTS; days) in reference to TTS = 30 days. BCSM were evaluated as flexibly dependent on continuous time (days) to surgery from diagnosis (TTS) using Fine and Gray competing-risk regression models, respectively, by HR status. Inverse propensity score-weighting was adjusted for demographic, clinical, and treatment variables impacting TTS. Adjusted BCSM risk grew with increasing TTS across all subtypes; however, the pattern and extent of the association varied. HR + /HER2 − patients exhibited the most pronounced increase in BCSM risk associated with TTS, with approximately exponential growth after 42 days, with adjusted subdistribution hazard ratios (sHR) of 1.21 (95% CI: 1.06–1.37) at TTS = 60 days, 1.79 (95% CI: 1.40–2.29) at TTS = 90 days, and 2.83 (95% CI: 1.76–4.55) at TTS = 120 days. In contrast, both HER2 + and HR −/HER2 − patients showed slower, approximately linear growth in sHR, although non-significant in HR −HER2 −.https://doi.org/10.1186/s13058-024-01949-9Surgical delayBreast cancer-specific mortalitySEER-MedicareTumor subtypeHormone-receptorHER2 |
| spellingShingle | Macall Leslie Salewon Rashmi Pathak William C. Dooley Ronald A. Squires Hallgeir Rui Inna Chervoneva Takemi Tanaka Surgical delay-associated mortality risk varies by subtype in loco-regional breast cancer patients in SEER-Medicare Breast Cancer Research Surgical delay Breast cancer-specific mortality SEER-Medicare Tumor subtype Hormone-receptor HER2 |
| title | Surgical delay-associated mortality risk varies by subtype in loco-regional breast cancer patients in SEER-Medicare |
| title_full | Surgical delay-associated mortality risk varies by subtype in loco-regional breast cancer patients in SEER-Medicare |
| title_fullStr | Surgical delay-associated mortality risk varies by subtype in loco-regional breast cancer patients in SEER-Medicare |
| title_full_unstemmed | Surgical delay-associated mortality risk varies by subtype in loco-regional breast cancer patients in SEER-Medicare |
| title_short | Surgical delay-associated mortality risk varies by subtype in loco-regional breast cancer patients in SEER-Medicare |
| title_sort | surgical delay associated mortality risk varies by subtype in loco regional breast cancer patients in seer medicare |
| topic | Surgical delay Breast cancer-specific mortality SEER-Medicare Tumor subtype Hormone-receptor HER2 |
| url | https://doi.org/10.1186/s13058-024-01949-9 |
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