FIRST PERSON | How long a wait is too long when it comes to treatment of breast cancer? A report published in the Dec. 19 issue of JNCI, Journal of the National Cancer Institute, states that after examining records from 6,622 women, the average time for a woman to wait for adjuvant chemotherapy (chemo given after surgery) for breast cancer is 12 weeks. After my surgery, I waited four weeks before chemotherapy began.
A main cause for delays in starting chemotherapy after surgery was immediate reconstruction. Flap surgeries allow for immediate breast reconstruction. This type of surgery requires a long recuperation period. Chemotherapy impedes healing. All incisions must be healed and all drains removed before chemotherapy can start.
I chose breast implants for reconstruction. This process was partially started during my mastectomy -- consider it partially immediate reconstruction. A tissue expander was put in after they removed my breast. Recovery time is significantly less than with flap surgery. I still had some stitches in when chemo started.
Testing and imaging delays
Testing such as 21-gene reverse-transcription polymerase chain reaction assay testing and MRIs increased the time frame from lumpectomy or mastectomy to the start of chemotherapy. Some doctors use post-surgical MRIs to determine if clear margins were reached. If they are unhappy with the results of the MRI, a second surgery may be required, thus increasing the time before chemo can start.
My oncologist did not feel that any further testing other than a MUGA scan was necessary following my mastectomy. The MUGA scan was performed in order to check heart function before starting on treatment with a monoclonal antibody. Even though I had to go through this imaging, it did not delay the start of chemotherapy.
One of the biggest causes of delays in starting chemotherapy treatment in minority women was access to health insurance. Black women who received Medicaid had the longest wait between surgery and the start of chemotherapy when compared to white women with private insurance. This is something that needs to change. When dealing with breast cancer, the faster and more aggressively it is treated, the better the prognosis for survival. There is no reason a woman should have to wait for treatment just because the government is paying for the chemotherapy.
Twelve weeks is too long to wait to start chemotherapy after surgery. Imaging should not have an impact on how long a person waits for chemo. Waiting too long, especially with aggressive forms of breast cancer could be the difference between life and death. I had imaging and started chemo just four weeks after my mastectomy. My outcome might have been very different had I been forced to wait an additional eight weeks before I started chemotherapy.
Lynda Altman was diagnosed with breast cancer in November 2011. She writes a series for Yahoo! Shine called "My battle with breast cancer."