Delaying surgery by 30 days, chemo by 90 days ups mortality risk

Some tumours can be very very aggressive and can literally spring up over night and grow very very fast - I know mine did - it increased in size loads while I was waiting for all the diagnostics to come back - couldn't start treatment until then and that all took around 30 days all in all for various reasons.

I'm not sure how this can apply to all stages and grades of BC. Mine was 7mm, too small to feel and very slow growing. My doctors all said it had probably taken about 8 years for it to grow large enough to be seen on a mammogram and all agreed I had plenty of time from the date of diagnosis to get second opinions, get the results for genetic testing (if positive would have changed my choice of what kind of surgery to have) and the results of oncotype test (done w cells from my needle biopsy) before making any decisions. The "safe" timetable for taking action must surely vary based on the aggressiveness of one's BC. Triple negative BC is a lot different than an "indolent" tubular hormone positive one, yet the article seems to make no distinction between types of BC.

It doesn't say anything about starting hormonal treatment before surgery

My comments relate to the time to surgery paper:

http://oncology.jamanetwork.com/article.aspx?artic...

I agree that this study likely excluded those in the SEER Medicare database who had received neoadjuvant (pre-surgery) endocrine therapy, because the original article says:

"They had surgery as first therapy and a definitive surgery date in Medicare claims of 180 days or less after diagnosis."

In addition, regarding neoadjuvant chemotherapy, it is stated:

"Patients receiving neoadjuvant chemotherapy were excluded, and chemotherapy and radiotherapy use were defined as being administered if given 1 year or less after surgery."

Regarding the definition of "diagnosis date", it isn't stated very clearly, but it seems like a biopsy date:

"The diagnosis date, used as the preoperative interval start date, was determined by using SEER clinical diagnosis date (which only consists of a month and year) and searching for the first biopsy date during that month or the subsequent month. Patients were excluded who had no such discernable biopsy date."

BarredOwl

[Edited to add: With regard to the time to surgery, I do not see any evidence or discussion that the small decreases measured here are due to the biopsy procedure per se. To me, it seems more likely that if the effect observed is real, it is because an invasive cancer left in the body longer has a greater opportunity to spread regionally or to distant site (just as a delay from mis-diagnosis can lead to a later stage at actual diagnosis).

The patients were Medicare patients, and those younger than 66 years were excluded. The mean age was about 75 yrs old.]