Thursday, August 4, 2011

Breast Cancer News (8/4): Is it safe to delay treatment?

After a breast cancer diagnosis, there's a natural sense of urgency to start treatment immediately. How long is it safe to wait? Today, we'll look at three recent studies on treatment delays for women with early, node-negative breast cancer.

Short delays before surgery not associated with significant changes in tumor size

In April, an MD Anderson study in the Annals of Surgery evaluated whether delays before breast cancer surgery affected tumor size for 818 clinically node-negative women. The median time from imaging to surgery was 21 days. The median difference in tumor size from mammogram to surgery was 0 cm, and from ultrasound to surgery was .1 cm. The researchers concluded, "Modest time intervals from imaging to surgery are not significantly associated with change in tumor size; thus, patients may undergo preoperative work-up without experiencing significant disease progression."

Senior researcher Dr. Funda Meric-Bernstam told Reuters Health, "Clearly, rapid treatment is desireable. However, taking a few weeks to coordinate care is safe. It's very unlikely there will be tumor progression."

Two studies on delays between surgery and radiation

Also in April, a study in Clinical Breast Cancer evaluated how delays between breast conserving surgery and the start of radiation affect local recurrence rates. 387 women with node-negative, early breast cancer were divided into four groups based on how long after surgery radiotherapy started - less than 60 days after surgery, 61 to 120, 121 to 180 and more than 180 days later. Five years later, "a delay in administering radiotherapy after breast-conserving surgery was not associated with an increased risk of local relapse." The authors did, however, acknowledge conflicting results from other published studies and noted that "a larger evaluation of this issue is warranted."

A Korean study in the May/June issue of Tumori evaluated the local recurrence rates for two groups of women with node-negative breast cancer treated with breast conserving surgery. The first group started radiation therapy within 6 weeks of surgery. The second group started more than six weeks after surgery. The eight-year "local control," meaning no local recurrence, rates were 94.5% in the less than six week group and 92.7% in the more than six week group. For women less than 40 years old, starting radiotherapy within six weeks of surgery was associated with "a higher local control rate." There was no statistically significant difference for older women. Also, the interval between surgery and radiation "had no impact on overall and distant metastasis-free survival." The authors concluded, "Early radiotherapy within 6 weeks of breast-conserving surgery is associated with increased local control in patients with node-negative breast cancer not undergoing chemotherapy."

The topic for today's blog was inspired by a recent Twitter chat where a breast cancer survivor advised the newly diagnosed not to rush to treatment, but to take time to explore options and seek second opinions. Twitter can be another valuable resource for breast cancer patients and survivors. Currently, a group of survivors, patients and medical professionals participate in a weekly chat under the #bcsm (breast cancer social media) hashtag. Conversations take place on Mondays at 9pm Eastern/6pm Pacific time. Recent topics have included "Advice for the Newly Diagnosed," and "How Breast Cancer Affects Families." To learn more, search for #bcsm on Twitter. I tweet under the name @ann_latestbc. I hope to see you there.

At, we'll continue to add breast cancer research on delays in treatment to our website and database. The studies discussed today can be found on the radiation and breast conserving surgery pages of our website.

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