Effect on survival of longer intervals between confirmed diagnosis and treatment initiation among low-income women with breast cancer

J Clin Oncol. 2012 Dec 20;30(36):4493-500. doi: 10.1200/JCO.2012.39.7695. Epub 2012 Nov 19.


Purpose: To determine the impact of longer periods between biopsy-confirmed breast cancer diagnosis and the initiation of treatment (Dx2Tx) on survival.

Patients and methods: This study was a noninterventional, retrospective analysis of adult female North Carolina Medicaid enrollees diagnosed with breast cancer from January 1, 2000, through December, 31, 2002, in the linked North Carolina Central Cancer Registry-Medicaid Claims database. Follow-up data were available through July 31, 2006. Cox proportional hazards regression models were constructed to evaluate the impact on survival of delaying treatment ≥ 60 days after a confirmed diagnosis of breast cancer.

Results: The study cohort consisted of 1,786 low-income, adult women with a mean age of 61.6 years. A large proportion of the patients (44.3%) were racial minorities. Median time from biopsy-confirmed diagnosis to treatment initiation was 22 days. Adjusted Cox proportional hazards regression showed that although Dx2Tx length did not affect survival among those diagnosed at early stage, among late-stage patients, intervals between diagnosis and first treatment ≥ 60 days were associated with significantly worse overall survival (hazard ratio [HR], 1.66; 95% CI, 1.00 to 2.77; P = .05) and breast cancer-specific survival (HR, 1.85; 95% CI, 1.04 to 3.27; P = .04).

Conclusion: One in 10 women waited ≥ 60 days to initiate treatment after a diagnosis of breast cancer. Waiting ≥ 60 days to initiate treatment was associated with a significant 66% and 85% increased risk of overall and breast cancer-related death, respectively, among late-stage patients. Interventions designed to increase the timeliness of receiving breast cancer treatments should target late-stage patients, and clinicians should strive to promptly triage and initiate treatment for patients diagnosed at late stage.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Breast Neoplasms / diagnosis
  • Breast Neoplasms / economics
  • Breast Neoplasms / mortality
  • Breast Neoplasms / therapy*
  • Cohort Studies
  • Female
  • Health Services Accessibility / economics
  • Humans
  • Mammography / economics
  • Medicaid / statistics & numerical data
  • Middle Aged
  • North Carolina / epidemiology
  • Retrospective Studies
  • Risk Factors
  • Socioeconomic Factors
  • Survival Rate
  • Treatment Outcome
  • United States
  • Waiting Lists*