PS5-11-02: Exploring Sociodemographic and Structural Barriers to Timely Surgery in ER+ HER2- Breast Cancer: A Single-Institution Study in the Bronx

Abstract Background: Surgical delays in breast cancer are associated with worse outcomes, prompting a Commission on Cancer 60-day time-to-surgery (TTS) benchmark for patients not receiving neoadjuvant treatment. In ER+ HER2- disease, delays beyond 42 days significantly increase breast cancer-specific mortality. Known risk factors for surgical delay include younger age, Medicaid insurance, lower income, and pre-operative MRI. Racial disparities remain inconsistently reported. This study evaluates risk factors for delayed surgery at an academic center that serves a largely urban, multiethnic and socioeconomically disadvantaged population, with attention to modifiable institutional contributors. Methods: A retrospective review was conducted of ER+ HER2- breast cancer patients diagnosed Jan 2023-Dec 2024. Included were women ≥18 undergoing upfront surgery; excluded were men, in situ disease, neoadjuvant therapy, and TTS >120 days. TTS was defined as the interval from biopsy to surgery. Demographic, clinical, and management variables were analyzed using univariate and multivariate linear regression. Results: Among 227 cases, mean TTS was 55.0 ± 21.0 days; 148 (65.2%) had surgery within 60 days and 70 (30.4%) within 42 days. Mean time from biopsy to first clinic visit was 16.7 ± 9.6 days; from clinic to surgery was 38.3 ± 20.0 days. TTS strongly correlated with time from clinic to surgery (Spearman ρ = 0.863, p < 0.001). Median age was 65 (IQR 57-73); younger patients (≤65) had longer TTS than older (>65), 57 vs. 48 days (p = 0.0037). On univariate analysis, longer TTS was associated with Black race (p = 0.042), Medicaid (p = 0.005), and mastectomy (p = 0.0044). On multivariate linear regression analysis controlling for demographic, clinical and management variables, significant delays were associated with Black race, ILC pathology, IORT, plastic surgery involvement, medical clearance, breast MRI, and surgery cancellation/rescheduling (all p < 0.05). Plastic surgery had the greatest impact (+17.2 days), followed by canceled surgery (+13.7), Black race (+10.1), IORT (+9.3), medical clearance (+8.9), ILC (+7.9), and MRI (+6.9). Conclusion: In this study, several modifiable and non-modifiable factors were associated with increased time to surgery among ER+ HER2- breast cancer patients. Notably, delays were significantly associated with Black race, ILC pathology, and logistical elements including plastic surgery coordination, IORT, medical clearance, and pre-operative breast MRI. The largest contributors to delay—plastic surgery involvement and canceled/rescheduled surgeries—highlight actionable targets for quality improvement. These findings underscore the need for institution-specific strategies to streamline surgical workflows and address disparities, particularly as delays beyond 42 days may adversely affect survival in this patient population. Citation Format: S. Jao, C. Pansa, V. Mehta, M. Scheckley, M. McEvoy, A. Gupta, E. Ravetch, S. Feldman. Exploring Sociodemographic and Structural Barriers to Timely Surgery in ER+ HER2- Breast Cancer: A Single-Institution Study in the Bronx [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-11-02.