Factors Associated with Delays in Breast Cancer Surgery Among Patients From Neighboring Hawaiian Islands Treated on O'ahu.

Abstract

Background: Breast cancer patients from neighboring Hawaiian Islands face challenges including limited access to specialists and geographic isolation. Surgical delays longer than 8 weeks from diagnosis can negatively impact survival. Time from diagnosis to surgery (TTS) and predictors of delay are unknown for this population.

Methods: Retrospective chart review was performed on breast cancer patients from neighboring Hawaiian Islands who underwent upfront surgery on O'ahu categorized as TTS of 8 weeks or longer. Demographic and clinical characteristics were evaluated. Chi-square and Fisher's exact tests were used for categorical analyses. Binary logistic regression adjusted for confounding variables.

Results: The study reviewed 221 breast cancer patients (2014-2024) from neighboring Hawaiian Islands. The mean TTS was 9.4 weeks. In the univariate analysis, TTS longer than 8 weeks was associated with post-pandemic diagnosis versus during and before the pandemic (41.8 vs. 16.3 vs. 418%), preoperative diagnostic testing compared with no testing (79.6 vs. 20.4%), plastic surgery consultation compared with no consultation (51.0 vs. 49.0%,), and mastectomy compared with breast-conserving surgery (61.2 vs. 37.8%) (all p < 0.005). Multivariate analysis showed post-pandemic diagnosis (odds ratio [OR], 2.84; 95% CI, 1.15-7.00; p = 0.023), time from biopsy to consultation (OR, 1.32; 95% CI, 1.13-1.56; p < 0.001), and preoperative diagnostic testing (OR, 3.22; 95% CI, 1.27-8.16; p = 0.014) as significant predictors of TTS longer than 8 weeks.

Conclusion: Nearly half of neighboring Hawaiian Islands breast cancer patients experienced delay in surgery. Streamlining preoperative management could meaningfully shorten the time from biopsy to surgery and improve access to care and outcomes for this population.