"We wanted to see whether delaying treatment affected mortality rates among women with breast cancer," says Electra D. Paskett, associate director for population sciences at OSUCCC-James. "It's been shown that early detection and appropriate, timely treatment can increase five year survival rates to as high as 98 percent. Until this study, we didn't know the profound effect delaying treatment could have," she said.

Paskett is the senior author on the study, which is published online by the Journal of Clinical Oncology. In the study, researchers retrospectively examined 1,786 women enrolled in North Carolina Medicaid system who were diagnosed with breast cancer from January 1, 2000 through December 31, 2002, using the linked North Carolina Cancer Registry-Medicaid Claims database. Follow-up data were available through July 31, 2006.

The median time from biopsy-confirmed diagnosis to the initiation of treatment was 22 days. Sixty-six percent of the women started treatment within 30 days, and nearly all (90 percent) started treatment within 60 days. There was no difference in survival rates for those treated by 60 days.

However, for one in ten women studied, treatment started more than 60 days after their cancer diagnosis. Among those who had advanced cases of breast cancer, a delay of more than 60 days was associated with an 85 percent higher risk of breast cancer-related death, and a 66 percent higher risk of death overall, compared with women who were treated sooner.

"We're finding as we do research, it is really the lower income population that suffers the highest burden of all diseases," says Paskett. "This study suggests that ten percent of women can't get access to care, or it takes a longer time to get access to care."

Paskett says interventions to remove barriers and improve the timeliness of breast cancer treatment should focus on late-stage patients. Paskett recently published a study that confirmed patient navigators, often part of the clinical team, help patients negotiate the various complexities of the health care system and play a valuable role in helping breast cancer patients start treatment earlier.

"This research shows we have an opportunity to improve breast cancer outcomes by helping women who are diagnosed at late-stage to get started with treatment sooner," says Paskett. "Even if the goal of treatment isn't curative, early treatment seems to prolong survival."

The study was funded by grant 1R01CA121317 from the National Cancer Institute.