Reasons To Wait A Short While
While information suggests having surgery within a few weeks and chemotherapy within a month is ideal, there are some very good reasons why you may wish to wait a few days or a few weeks to begin treatment.
Most surgeons and oncologists will reassure you that you have some time, though there are always exceptions to that general rule . Advantages of taking some time include:
Breast Cancer Doctor Discussion Guide
Get our printable guide for your next doctors appointment to help you ask the right questions.
Choices In Breast Reconstruction
Breast surgery to remove cancer is only one part of the equation for many women. In order to feel whole once again, breast reconstruction becomes a vital step in the process. When and how this step is performed will vary, depending on the unique circumstances of each patient. Like the rest of your cancer treatment, there are choices in reconstruction that allow us to work together to customize your plan to your precise needs and goals.
Some Considerations Before Scheduling Your Breast Cancer Treatment
Following a diagnosis but before scheduling your breast cancer treatment, you may need to allow time for:
- A second opinion If you have any concerns or doubts about your diagnosis, getting a second opinion may provide you with some additional insights. Having another physician take a look at your results may provide more reassurance about which breast cancer treatment options are most appropriate for you.
- Lab results to come in If a follow-up test is necessary, its worth waiting for the results to come in before jumping into treatment. In many cases, the lab tests will require important information in determining which types of breast cancer treatment may be best.
- A treatment plan to be developed Treating breast cancer requires complex decision making that takes into account a multitude of factors unique to the patient. Creating a breast cancer treatment plan requires experienced physicians to assess all of the available information and determine which treatment approaches would be most effective.
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Prompt Surgery Is Better
Because Im a surgeon Ill take a look at Bleicher et al first. This study looks at two large cancer databases, the Surveillance, Epidemiology, and End Results -Medicarelinked database and the National Cancer Database . The SEER-Medicare cohort included Medicare patients older than 65 years, and the NCDB cohort included patients cared for at Commission on Canceraccredited facilities throughout the United States. Analyses performed assessed overall survival as a function of time between diagnosis and surgery and evaluated five intervals . It also looked at disease-specific survival at 60 day intervals. The patient cohort included women diagnosed with invasive breast cancer that had not metastasized beyond axillary lymph nodes who were treated with surgery first. Patients with inflammatory breast cancer were excluded, which makes sense because inflammatory cancer is generally treated first with chemotherapy. The SEER-Medicare cohort included 94,544 patients 66 years or older diagnosed between 1992 and 2009, while the NCDB cohort included 115,970 patients 18 years or older diagnosed between 2003 and 2005.
The tale is told by this graph, from the SEER-Medicare cohort and the NCDB cohort :
You might wonder why there is less of an effect of treatment delay in stage III disease. So did the authors:
Will The Nhs Fund An Unlicensed Medicine
It’s possible for your doctor to prescribe a medicine outside the uses it’s licensed for if they’re willing to take personal responsibility for this ‘off-licence’ use of treatment.
Your local clinical commissioning group may need to be involved, as it would have to decide whether to support your doctor’s decision and pay for the medicine from NHS budgets.
Page last reviewed: 28 October 2019 Next review due: 28 October 2022
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Delay In Surgical Treatment
Surgery is an important part of breast cancer treatment. Most patients with breast cancer require surgical intervention, particularly patients with early stage breast cancer, in which neoadjuvant chemotherapy is less commonly used, and surgery is the first intervention that patients receive.
Koca compared patients with breast cancer who underwent hand therapy 1 year before the COVID-19 pandemic with those who underwent surgery 1 year after the start of the pandemic. Results showed that tumor size, axillary lymph node positivity, and NAC were all higher in patients who underwent surgery in the first year after the start of the pandemic than in those who underwent surgery before the pandemic. Khader analyzed the time interval between diagnosis, surgery, and lymph node metastasis in 355,443 patients with cN0 breast cancer. After controlling for relevant factors, a one-month delay in surgery was associated with an increased likelihood of nodal positivity and decreased OS . Compared with patients who underwent surgeryless than 4weeks after diagnosis, patients who underwent surgerymore than 12weeks after diagnosis had nodal positivity and relative risk of 5.3% and 1.34 , respectively. This study suggests that delayed breast cancer surgery in cN0 patients is associated with an increased likelihood of axillary ascent and reduced survival rates.
The above studies suggest that delaying surgery for longer than 4 weeks might worsen patient outcomes.
Youve Been Diagnosed With Breast Cancer How Soon Do You Need Treatment
Timely surgery for breast cancer is obviously better than delaying surgery, but how long can a patient safely wait for surgery once diagnosed. Because a randomized controlled clinical trial to answer this question would be unethical, this has been a difficult question to answer. Fortunately, a new study provides an estimate of how much of a delay it takes before outcomes start to suffer.
A new year is upon us yet again, and Science-Based Medicine has been in existence for eight years now. It seems only yesterday that Steve Novella approached me to ask me to be a contributor. Our part-serious, part-facetious predictions for 2016 notwithstanding, one thing about 2016 is certain: I will almost certainly encounter some form of cancer quackery or other and deconstruct it, probably multiple forms. In any case, a topic Ive been meaning to write about is based on a couple of studies that came out three weeks ago that illustrate why, even if a patient ultimately comes around to science-based treatment of his cancer, the delay due to seeking out unscientific treatments can have real consequences.
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Urgent Referral For Suspected Cancer
Your GP might arrange for you to see a hospital doctor urgently. This might be because you have symptoms that could be due to cancer. An urgent referral can be worrying. But remember that 9 in every 10 people referred this way will not have a diagnosis of cancer.
In England, an urgent referral means that you should see a specialist within 2 weeks. In Northern Ireland, the 2 week wait only applies for suspected breast cancer.
Scotland, Wales and Northern Ireland don’t have the 2 week time frame to see a specialist. But wherever you live, a specialist will see you as soon as possible.
Treating Stage Iii Breast Cancer
In stage III breast cancer, the tumor is large or growing into nearby tissues , or the cancer has spread to many nearby lymph nodes.
If you have inflammatory breast cancer: Stage III cancers also include some inflammatory breast cancers that have not spread beyond nearby lymph nodes. These cancers are treated slightly different from other stage III breast cancers. You can find more details in Treatment of Inflammatory Breast Cancer.
There are two main approaches to treating stage III breast cancer:
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Timeline After Breast Cancer Diagnosis
Receiving a breast cancer diagnosis can create many feelings and emotions. Since some breast cancer diagnoses come with a bleak outlook, its common to want to start a treatment plan as soon as possible.
This article is designed to give you a comprehensive understanding of which factors play a role in your prognosis and what you should expect in the coming days, weeks and months following your diagnosis.
Optimal Wait Time Before Surgery
We lead busy lives. Some people wonder if they can wait until an upcoming vacation to have surgery, or until their children are back in school. Others hope to wait until their insurance kicks in at a new job, or until they are able to find insurance. And not everyone feels quite ready to have surgery right after being diagnosed.
The average wait time until surgery has actually been increasing, with the average delay being 21 days in 1998, 31 days in 2003, and 41 days in 2008.
How long can you wait? Let’s look at studies of overall survival as well as special groups.
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You Have Plenty Of Time To Make Decisions
Making good decisions is the most difficult part of having breast cancer. You will feel pressed for time to learn everything and start your treatment as soon as possible. Time is usually on your side. You must work with your team to learn everything about your cancer and treatment options. We created the Breast Cancer School for Patients to quickly teach you to be your own expert in breast cancer. You will make better decisions being your own best advocate.
Cancer Beyond The Breast Area
A locally advanced recurrence means that the breast cancer has spread beyond the breast and the lymph nodes under the arm . This includes areas near to or around the breast but has not spread to other parts of the body.
A locally advanced cancer might come back in one or more of the following:
- the chest wall
- lymph nodes under the breastbone or between the ribs
- the nodes above the collarbone
- lymph nodes around the neck
Symptoms can include, changes in the breast, and swelling in the lymph nodes above and below the collarbone, the neck, and around the breast bone.
The tests you might have are usually the same as for checking for a local recurrence.
Do speak to your nurse or doctor if you notice any of these changes.
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Breast Cancer Treatment: Beyond Surgery
Many women might undergo additional treatments before or after their breast surgery. Chemotherapy and radiation therapy are the most familiar to most patients, but another common treatment option is anti-hormone therapy.
This treatment targets the estrogen receptors commonly found in breast cancers. Anti-hormone drugs block these receptors to prevent the cancer cells from reproducing. Patients typically remain on the anti-hormone drugs for five years, but women with a higher risk of recurrence may take the medications for 10 years.
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Precancer Or Noninvasive Cancer
There is some debate over whether to consider DCIS precancer or noninvasive cancer. Generally, DCIS is considered noninvasive cancer, while lobular carcinoma is considered a precancerous condition, also called lobular neoplasia.
Learning that your condition is precancerous may make you worry that it will inevitably progress to cancer. This is not always the case, however, precancerous conditions like LCIS should be monitored closely.
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About Breast Cancer Recurrence
During surgery to remove early-stage breast cancer, surgeons remove all the cancer they can see. In some cases, there may be individual cells circulating in the bloodstream or hiding in the bones or other places in the body. These cells may be inactive and not growing, or what doctors call dormant. But at some point in the future, the cells may start growing and cause a recurrence.
Doctors prescribe treatments after surgery such as hormonal therapy, chemotherapy, and targeted therapies to destroy any cancer cells left behind and reduce the risk of recurrence.
The risk of recurrence is unique to each person diagnosed with early-stage breast cancer and depends on a number of factors, including:
- cancer stage
- number of positive lymph nodes
- hormone receptor status
- HER2 status
- age at diagnosis
Doctors work very hard to estimate the risk of recurrence for each person. They use that estimate to tailor a treatment plan you can start after surgery to keep the risk of recurrence as low as it can be.
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How Much Experience Do You Have Treating My Type And Stage Of Breast Cancer
Oncologists who are experienced in not only treating breast cancer but in your specific type of breast cancer are typically better equipped to explain and deliver the full range of treatment options. You should feel comfortable asking your doctor about his or her experience. Doctors and the hospitals they may work for are not required by law to publish the survival rates of the patients they treat, but some choose to do so. Others may be willing to provide these statistics upon request.
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Does Cancer Treatment Always Need To Be Started Right Away
Sometimes, it’s important to start treatment as quickly as possible, but that’s not always the case. Planning cancer treatment can be complex and might take some time, depending on the type and stage of your cancer. There are many factors that will affect when treatment can or should be started. Here are some reasons why there are differences in when treatments start.
Treatment might need to be started quickly if:
- You have a type of cancer that needs to be treated right away, like some leukemias, lymphomas, and certain other cancers that tend to be aggressive .
- You have a tumor that’s pressing on an organ or other vital part of the body, and treatment is needed to relieve the pressure.
Some patients can wait a few weeks or a few months to start treatment because their type of cancer does not tend to grow as fast as others. When treatment doesn’t need to start immediately, it might be delayed if:
- You are waiting to get lab results back that will help decide what treatment option is best.
- You have already had surgery to remove a tumor, and you need time to recover before starting more treatment.
- You need to make adjustments at home, work, or for child care before starting treatment.
- There are other personal factors and health problems that must be worked around.
- You want more time to get a second opinion.
Studies On Time To Surgery And Survival
Several studies have been done, but there are some differences in how these were conducted that can affect the results. For example, some studies have looked at the time between a definitive diagnosis and surgery, and others have looked at the time between the onset of symptoms and the time of surgery. Some have looked at averages of all people, whereas others have separated out people based on age, tumor type, and receptor status. Studies can also be skewed, as doctors may recommend surgery sooner for women who have more aggressive tumors. Let’s look at time to surgery and survival rates in different groups of people.
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A Few Facts About Time To Treatment:
- The average time from the date of cancer diagnosis to the day of lumpectomy surgery is about 32 days. The average time to mastectomy surgery is about 40 days.
- It can take anywhere from 3 to 12 months from cancer diagnosis to complete your final treatments, and up to ten years if you need hormonal therapy. It is a marathon. Conserve your emotional and physical efforts for the challenges ahead.
Genetics And Family History
Treatment for breast cancer may depend partly on having a close relative with a history of breast cancer or testing positive for a gene that increases the risk of developing breast cancer.
Patients with these factors may choose a preventive surgical option, such as a bilateral mastectomy.
Clinical trials are studies in which patients volunteer to try new drugs, combinations of drugs, and methods of treatment under the careful supervision of doctors and researchers. Clinical trials are a crucial step in discovering new breast cancer treatment methods.
Emerging treatments for breast cancer being studied in clinical trials include:
- PARP inhibitors that block protein used to repair DNA damage that occurs during cell division are being used and tested for TNBC.
- Drugs that or prevent androgen production are being used and tested for TNBC.
If youre interested, ask your oncologist for information about available trials.
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Survival Happens Every Day
These rough estimates for how long breast cancer takes to treat can be helpful to plan your life around treatment. More importantly, they provide a light at the end of the tunnel for you to focus on. However, for your daily sanity, it may be better to break down your treatment into smaller parts. Take it from one day to the next. Remember, every day you make it, youre already winning. These factors all affect how long breast cancer takes to treat.
Radiation Therapy And Mastectomy
Most women who have a mastectomy dont need radiation therapy if theres no cancer in the lymph nodes.
In some cases, radiation therapy is used after mastectomy to treat the chest wall, the axillary lymph nodes and/or the lymph nodes around the collarbone.
For a summary of research studies on mastectomy versus lumpectomy plus radiation therapy and overall survival in early breast cancer, visit the Breast Cancer Research Studies section.
For a summary of research studies on radiation therapy following mastectomy for invasive breast cancer, visit the Breast Cancer Research Studies section.
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