Is It Okay to Delay Surgery in Very Early Breast Cancer?

The COVID-19 pandemic has led to cancelled surgeries, delayed treatments, and patients hesitating to seek care. One concern has been the effect this may have on a patient’s health down the road. For patients with ductal carcinoma in situ (DCIS) breast cancer, delaying surgery may not impact their overall survival, according to a study.

“The most pressing question today is what will surgical delays due to the pandemic mean for patient outcomes, and the reality is that we will only have the answers years from now,” said lead study author Christina Minami, MD, MS, in a press release.

“In the meantime, these data should provide some reassurance and encouragement—they don’t indicate that outcomes will be changed dramatically,” continued Dr. Minami, a surgeon in the Division of Breast Surgery at the Brigham and Women’s Hospital. “But we do encourage patients to follow up with their surgeons on a care plan as COVID-19 surges grow or subside locally.”

Dr. Minami and colleagues queried the National Cancer Database to identify patients with DCIS or ER+ cT1-2N0 breast cancer treated between 2010 and 2016 to determine time to surgery. A total of 378,839 patients were analyzed; of those undergoing primary surgery, 98% had a time to surgery within 120 days. For cT1N0 and cT2N0 patients chosen for neoadjuvant endocrine therapy, among cT1N0 patients, 59.6% underwent surgery within 120 days, and among cT2N0 patients, 30.9% were operated on within 120 days. Time to surgery did not affect overall survival among DCIS or neoadjuvant endocrine therapy patients. In DCIS patients, a correlation was observed between increased time to surgery and greater pathological upstaging risk. When using <60 days as a reference group, early-stage estrogen receptor-positive (ER+) patients who underwent surgery within 60 to 120 days had an odds ratio (OR) of 1.15 (95% confidence interval [CI], 1.08 to 1.22); patients whose time to surgery was >120 days had an OR of 1.44 (95% CI, 1.24 to 1.68). For ER- patients, the OR for patients treated within >120 days was 1.36 (95% CI, 1.01 to 1.82). No difference was observed for patients with invasive cancer, regardless of their initial treatment strategy.

“Anxiety for both surgeons and patients alike stems from the unknown—what does a delay in surgery mean for our patients?” Dr. Minami said. “We sought to help address questions about outcomes. Ideally, we’d like to have randomized, controlled studies, but under the circumstances, we needed to take the more unconventional approach by looking at retrospective data.”

The study was published in the Journal of the American College of Surgeons.