Diagnosis-to-surgery lead time and future-health worry in women with primary breast cancer: a longitudinal Swedish registry-based cohort study.
7 affiliations
- 1Department of Diagnostics and Intervention/Surgery, Umeå University, Umeå, 901 87, Sweden. [email protected].
- 2Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
- 3Department of Breast-, Endocrine Tumors and Sarcoma, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden.
- 4Heart Centre, Norrland University Hospital, Region Västerbotten, Umeå, Sweden.
- 5Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
- 6Department of Diagnostics and Intervention/Surgery, Umeå University, Umeå, 901 87, Sweden.
- 7Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Abstract
Purpose
The interval between breast cancer diagnosis and surgery is psychologically demanding, and meeting the Swedish standardised care pathway target has remained challenging. We examined whether diagnosis-to-surgery lead time is associated with patient-reported psychological outcomes.Methods
We conducted a longitudinal cohort study using Swedish National Quality Register for Breast Cancer data (2020-2024). The cohort comprised 2,906 women with primary invasive breast cancer undergoing surgery, with patient-reported outcome measure (PROM) data at baseline (n = 2,906), 6 months (n = 2,638), and 12 months (n = 2,678). Lead time from biopsy to surgery was modelled continuously (per 1 SD ≈ 19 days). The primary outcome was worry about future health (EORTC QLQ-BR23 item 43); secondary outcomes were general worry, tension, depressed mood, and overall quality of life. Associations were estimated using mixed-effects cumulative link models adjusted for clinical and tumour factors, pandemic era, patient, and healthcare region.Results
Median lead time was 32 days (IQR 23-42). Longer lead time was associated with greater worry about future health (adjusted OR 1.15 per SD, 95% CI 1.04-1.27), while associations with the secondary outcomes were smaller and not statistically significant. At baseline, high future-health worry was more common with lead times > 35 vs. ≤ 35 days (42.2% vs. 35.1%).Conclusion
Longer diagnosis-to-surgery lead time was associated with greater future-health worry, with smaller, non-significant associations for general distress and quality of life. The findings highlight the preoperative waiting period as a potential context for improved communication about expected timelines and reasons for delay.
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BibTeX
@article{eriksson2026diagnosistosurgery,
title = {{Diagnosis-to-surgery lead time and future-health worry in women with primary breast cancer: a longitudinal Swedish registry-based cohort study.}},
author = {Johan Eriksson and Irma Fredriksson and Lena Lindholm and Micael Appelblad and Malin Sund},
journal = {Breast cancer research and treatment},
year = {2026},
month = oct,
doi = {10.1007/s10549-026-08107-z},
url = {https://europepmc.org/article/MED/42894063},
note = {CC BY},
}
RIS
TY - JOUR
TI - Diagnosis-to-surgery lead time and future-health worry in women with primary breast cancer: a longitudinal Swedish registry-based cohort study.
AU - Johan Eriksson
AU - Irma Fredriksson
AU - Lena Lindholm
AU - Micael Appelblad
AU - Malin Sund
PY - 2026
DA - 2026/10/18
JO - Breast cancer research and treatment
DO - 10.1007/s10549-026-08107-z
UR - https://europepmc.org/article/MED/42894063
AB - Purpose The interval between breast cancer diagnosis and surgery is psychologically demanding, and meeting the Swedish standardised care pathway target has remained challenging. We examined whether diagnosis-to-surgery lead time is associated with patient-reported psychological outcomes.Methods We conducted a longitudinal cohort study using Swedish National Quality Register for Breast Cancer data (2020-2024). The cohort comprised 2,906 women with primary invasive breast cancer undergoing surgery, with patient-reported outcome measure (PROM) data at baseline (n = 2,906), 6 months (n = 2,638), and 12 months (n = 2,678). Lead time from biopsy to surgery was modelled continuously (per 1 SD ≈ 19 days). The primary outcome was worry about future health (EORTC QLQ-BR23 item 43); secondary outcomes were general worry, tension, depressed mood, and overall quality of life. Associations were estimated using mixed-effects cumulative link models adjusted for clinical and tumour factors, pandemic era, patient, and healthcare region.Results Median lead time was 32 days (IQR 23-42). Longer lead time was associated with greater worry about future health (adjusted OR 1.15 per SD, 95% CI 1.04-1.27), while associations with the secondary outcomes were smaller and not statistically significant. At baseline, high future-health worry was more common with lead times > 35 vs. ≤ 35 days (42.2% vs. 35.1%).Conclusion Longer diagnosis-to-surgery lead time was associated with greater future-health worry, with smaller, non-significant associations for general distress and quality of life. The findings highlight the preoperative waiting period as a potential context for improved communication about expected timelines and reasons for delay.
SN - 0167-6806
SN - 1573-7217
ER -