Diagnosis-to-surgery lead time and future-health worry in women with primary breast cancer: a longitudinal Swedish registry-based cohort study

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.