Breast cancer surgery delays tied to higher upstaging, faster tumor growth

Editor's Note

Each month of delay between breast cancer diagnosis and surgery raises the likelihood of tumor upstaging, nodal spread, and in vivo tumor growth, according to a national database analysis published in Annals of Surgical Oncology on July 23.

The researchers reviewed records from more than 1 million patients with nonmetastatic, noninflammatory breast cancer treated at Commission on Cancer accredited facilities between 2010 and 2020. All patients underwent surgery as first treatment. The study assessed risks of primary tumor upstaging, nodal involvement, and growth rates while awaiting surgery.

According to the article, 11.5% of patients experienced primary tumor upstaging and 14.1% had nodal upstaging overall. For every 30 days of delay, the odds of tumor upstaging rose by 11% for ductal carcinoma in situ, 13% for cT1 tumors, and 18% for cT2 tumors. Patients with triple-negative cancers faced the greatest risk, with a 21% higher chance of upstaging per month compared with 13% in hormone receptor–positive and 9% in HER2-positive tumors. The adjusted odds of nodal upstaging for clinically node-negative patients increased by 7% per month.

The outlet reports tumor growth accelerated with size. On average, cT1a tumors took nearly 4 months to grow 1 mm, while cT2 tumors grew that amount in under 2 months. Growth rates also varied by phenotype: triple-negative tumors grew fastest at 39 days per millimeter, compared with 71 days for hormone receptor–positive and 148 days for HER2-positive tumors. These findings suggest larger and biologically aggressive tumors are more vulnerable to clinically significant growth during surgical delays.

While some upstaging reflects inaccuracies in initial clinical staging, delays were directly responsible for measurable increases in tumor burden and nodal spread. The researchers concluded timelier surgery is critical to limit stage progression, especially for patients with larger or triple-negative tumors. These data also provide clinicians with quantifiable measures to guide discussions with patients concerned about the risks of waiting for surgery.