A longer interval between biopsy and surgery is associated with greater worry about future health in women with breast cancer, according to a cohort study based on the Swedish breast cancer quality register and published in Breast Cancer Research and Treatment.
What was known
The interval between diagnosis and surgery is a psychologically demanding period. Sweden has a standardised care pathway with target times, but meeting them has proved difficult in recent years. What was missing was evidence from patients’ own reports on whether waiting longer worsens emotional wellbeing.
What this work adds
This is a longitudinal cohort study drawn from the Swedish National Quality Register for Breast Cancer, covering 2020 to 2024. It included 2,906 women with primary invasive breast cancer who underwent surgery, with patient-reported outcome measures collected at baseline, six months (2,638) and 12 months (2,678). Lead time from biopsy to surgery was modelled as a continuous variable, with each standard deviation corresponding to roughly 19 days. The primary outcome was worry about future health (item 43 of the EORTC QLQ-BR23 questionnaire); secondary outcomes were general worry, tension, depressed mood and overall quality of life. Models were adjusted for clinical and tumour factors, the pandemic era, patient characteristics and healthcare region.
Main results
Median time to surgery was 32 days (interquartile range 23-42). Each additional standard deviation of waiting was associated with greater worry about future health (adjusted odds ratio 1.15; 95% confidence interval 1.04-1.27). Associations with the remaining measures were smaller, without statistical significance. At baseline, high worry was more common among women waiting more than 35 days than among those waiting 35 days or less (42.2% versus 35.1%).
What it means
The authors do not conclude that delay by itself causes serious psychological harm — the increase in odds is modest — but rather that the preoperative waiting period is a sensitive moment in which information matters. They propose improving communication about expected timelines and about the reasons for any delay, instead of leaving that time silent. The effect on general distress and quality of life was smaller and not significant, which fits an impact concentrated on uncertainty about the future.
A view from the breast unit
The study is a reminder that organising the diagnostic and surgical pathway is also a matter of perceived quality: explaining which steps come next, when they are expected and why they are delayed does not replace shortening the waits, but it addresses a measurable source of distress. Tracking the biopsy-to-surgery interval and asking patients about it are two simple indicators any unit can add to its routine.
Reference: Eriksson J, Fredriksson I, Lindholm L, Appelblad M, Sund M. Diagnosis-to-surgery lead time and future-health worry in women with primary breast cancer: a longitudinal Swedish registry-based cohort study. Breast Cancer Research and Treatment, 2026. https://doi.org/10.1007/s10549-026-08107-z
