15 December 2019

Don't delay surgery for very early-stage breast cancer

While it's not necessary to get treated immediately for ductal carcinoma in situ (DCIS), delays do have an effect and long delays should be avoided.

Delaying surgery for a non-invasive breast cancer can have dire consequences, a new study shows.

Longer delays in surgery for ductal carcinoma in situ (DCIS) breast cancer lead to a higher risk of invasive ductal carcinoma and a slightly lower survival rate, researchers found.

Long delays should be avoided

"For each month of delay, there was well under a 1% difference in survival. But for each month of delay, there was an approximate 1% increase in the finding of invasive cancer," said study author Dr Richard Bleicher, a professor of surgical oncology at Fox Chase Cancer Center, in Philadelphia.

"The survival difference with a delay is small," Bleicher noted in a centre news release. "While it's not an emergency to get treated immediately, delays do have an effect and long delays should be avoided."

DCIS occurs when abnormal cells form in the milk duct of the breast and is the earliest stage of breast cancer. When cancerous cells spread beyond the milk duct, it becomes invasive ductal carcinoma.

Standard treatment for DCIS is surgery and radiotherapy, along with endocrine therapy. But research suggests that some DCIS may never progress to invasive disease, and clinical trials are being conducted to determine whether DCIS can be observed, rather than surgically removed.

Observation represents infinite delay

This study "suggests that delays in operative management of DCIS are associated with invasion and slightly worse short-term outcomes," Bleicher said. "Since observation represents infinite delay, it suggests that observation should not yet be pursued outside of a clinical trial in patients who will tolerate excision."

The study included more than 140 600 US women (123 947 with DCIS, 16 668 with invasive ductal carcinoma). They were diagnosed between 2004 and 2014.

Survival was compared with five time intervals in delays to have surgery: less than 30 days, 31–60 days, 61–90 days, 91–120 days, or 121–365 days.

Overall survival was 95.8%, with a median time from diagnosis to surgery of 38 days. However, each increase in diagnosis-to-surgery interval was associated with a 7.4% increase in the risk of death.

The study was published in the Annals of Surgical Oncology.

Image credit: iStock


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