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Article

Waiting Times for Surgery and Radiotherapy Among Breast Cancer Patients in Switzerland: A Cancer Registry-Based Cross-Sectional and Longitudinal Analysis

by
Christoph Oehler
1,*,†,
Michel Eric Nicolas Zimmermann
1,‡,
Mohsen Mousavi
2,
Kattic Ram Joorawon
1,
Marcel Blum
2,
Christian Herrmann
3 and
Daniel Rudolf Zwahlen
1,†
1
Department of Radiation Oncology, Kantonsspital Winterthur, 8400 Winterthur, Switzerland
2
Cancer Registry of Eastern Switzerland, 9000 St. Gallen, Switzerland
3
Eurospine, The European Spine Society, 8610 Uster, Switzerland
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
‡
Deceased.
Radiation 2025, 5(3), 23; https://doi.org/10.3390/radiation5030023
Submission received: 11 June 2025 / Revised: 20 July 2025 / Accepted: 24 July 2025 / Published: 3 August 2025
(This article belongs to the Section Radiation and Its Application in Oncology and Radiation Protection)
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Simple Summary

This study examined how long women with early-stage breast cancer in Switzerland waited for diagnosis, surgery, and radiotherapy, comparing cancer registry data from 2003 to 2005 and 2015 to 2017. It focused on patients treated with surgery without chemotherapy. In 2003–2005, the average wait was 4 days from biopsy-to-diagnosis, 19 days from diagnosis-to-surgery, and 57 days from surgery-to-radiotherapy. Longer waits for surgery were more common in cities, public hospitals, elderly, those with basic insurance, and after mastectomy. Radiotherapy delays were longer in cities and after mastectomy. Between the two time periods, the wait for surgery increased in Eastern Switzerland, but radiotherapy timing remained stable. Despite these delays, five-year survival rates improved from 76.7% to 88.4%. However, longer waits between diagnosis and surgery did not affect short-term survival. These findings highlight the importance of monitoring treatment delays and ensuring timely, equitable access to cancer care.

Abstract

Background: Delays in breast cancer treatment negatively affect prognosis and have increased over time. Data on waiting times in Switzerland are limited. Patients and Methods: This study analyzed cancer registry data from 2003 to 2005 (2628 patients) and 2015 to 2017 (421 patients) to evaluate waiting times for diagnosis, surgery, and radiotherapy; temporal trends; and survival in women with stage I–III invasive breast cancer treated with surgery without chemotherapy. Associations with demographic/clinical factors and overall survival (OS) were assessed using ANOVA, uni-/multivariable regression, Kaplan–Meier, and Cox regression. Results: From 2003 to 2005, mean intervals were biopsy-to-diagnosis 4.3 days, diagnosis-to-surgery 18.8 days, biopsy-to-surgery 26.8 days, and surgery-to-radiotherapy 56.7 days. Longer diagnosis-to-surgery times were associated with metropolitan areas, public hospitals, basic insurance, mastectomy, and older age (all p < 0.001). Radiotherapy delays were also longer in metropolitan areas and after mastectomy (p < 0.001). Between 2003–2005 and 2015–2017, diagnosis-to-surgery times rose in Eastern Switzerland (from 21.3 to 31.2 days), while radiotherapy timing remained stable. Five-year overall survival improved (from 76.7% to 88.4%), but was not significantly impacted by diagnosis-to-surgery intervals. Conclusions: Despite timely surgery in Switzerland (2003–2005), disparities existed, and time to surgery increased by 2015–2017. Reducing waiting times remains important despite no significant short-term OS impact.

1. Introduction

Breast cancer diagnosis and treatment delays concern health care systems globally due to their potential impact on survival [1,2,3,4,5]. Evidence shows that delays, especially cumulative delays, are associated with worse overall survival (OS) [6,7,8,9,10,11]. A prolonged interval until postoperative radiotherapy increases local recurrence risk and worsens OS [12,13,14,15]. This effect is pronounced in women with stage I-II invasive breast cancer [2,7].
The need for timely intervention in patients with breast cancer has prompted many countries to implement clinical guidelines and time targets for diagnosis and treatment alongside clinical auditing systems [16,17,18]. Notably, a recent international framework emphasized timeliness in breast cancer care, with a timeframe of 28 to 32 days between biopsy and first treatment [16]. In Switzerland, breast cancer care optimization has included quality criteria integrated into the certification process since 2007 by the Swiss Society of Senology (SGS), which aims for patient orientation within 5–8 days post-biopsy and initial treatment within 10–15 days thereafter [19].
Concerns over increasing waiting times over time for breast cancer treatment attributed to preoperative evaluation components and demographic factors have prompted calls for periodic assessment and intervention [4]. Bleicher et al. reported that the median interval between the first physician visit and surgery increased in the US from 21 days in 1992 to 32 days in 2005 [4]. Measurable delays were significantly associated with demographics such as younger age (<80 years), black and Hispanic ethnicity, and metropolitan areas. They stated that preoperative components such as imaging modalities, biopsy type, and clinician visits, each led to additional delays [4].
Currently, no data are available on waiting times and temporal trends in Switzerland. In this study, we retrospectively analyzed waiting times until diagnosis, surgery and radiotherapy in stage I-III breast cancer patients in Switzerland using cancer registry data from two time periods: 2003–2005, covering nearly 50% of the Swiss population across seven registries, and 2015–2017, based on data from the Eastern Switzerland cancer registry. Additionally, data from Eastern Switzerland were used to assess how the time from diagnosis-to-surgery affected OS in both periods.

2. Materials and Methods

We conducted an exploratory retrospective cancer registry study, including a cross-sectional pooled analysis of seven cancer registries from 2003 to 2005 and a longitudinal comparative analysis of the Eastern Switzerland cancer registry from 2003 to 2005 and 2015 to 2017.

2.1. Study Population

We retrospectively investigated in 2017–2018 the dataset of 4820 women diagnosed with invasive breast cancer between January 1st, 2003 and December 31st, 2005. This time period was chosen due to the completeness of the cantonal datasets at the time of data collection (2008–2009). Data were gathered by the cancer registry of Eastern Switzerland (sga). This database was designed to meet the European Society of Breast Cancer Specialists (EUSOMA) Audit system requirements for the Quality of Breast Cancer Treatment criteria [20]. Patients were identified from seven population-based cancer registries covering approximately 3.5 million inhabitants (47% of the Swiss population). Follow-up information was regularly provided to the cancer registries by the cantonal authorities (vital status) and medical institutions (medical follow-up events). Detailed information on patient and tumor characteristics, diagnosis circumstances, and treatments planned and delivered was collected by trained staff of seven population-based Swiss cancer registries: Geneva (ge), Valais (vs), Ticino (ti), Basel (ba), Zurich (zh), Eastern Switzerland (sga), and Grisons-Glarus (gg). For the longitudinal and survival analyses, we retrospectively analyzed the databases of the cancer registry of Eastern Switzerland in 2024, covering approximately 8% of the Swiss population, including 1164 patients with breast cancer diagnosis between 1 January 2015 and 31 December 2017. The study and study amendment were approved by the Ethics committee of St. Gallen (EKOS) as a registered study without informed consent in 2008 and 2024, as indicated by the approval number 2024-02547/EKOS 24/241.

2.2. Inclusion and Exclusion Criteria

Patients included in the analysis were female, age 18 and above, underwent surgery (breast-conserving surgery or mastectomy) with curative intent for stage I–III invasive breast cancer. Patients with non-adenocarcinoma, stage IV disease, receiving neoadjuvant/adjuvant chemotherapy, neo-adjuvant hormonal therapy or unknown/palliative therapy were excluded.

2.3. Outcomes

The primary objective of this exploratory study was to investigate the timeliness of four waiting times (biopsy-to-diagnosis, diagnosis-to-surgery, biopsy-to-surgery, and surgery-to-radiotherapy) in comparison to SGS guidelines and their dependence on patient and demographic variables (geography, patient age, body mass index (BMI), type of surgery, facility status, insurance status, clinical study inclusion, tumor board presentation, and nationality) using pre-existing data from seven cancer registries covering nearly half of the Swiss population from 2003 to 2005.
The secondary objectives included a longitudinal analysis of temporal trends in the diagnosis-to-surgery and surgery-to-radiotherapy intervals using data from one cancer registry (Eastern Switzerland) over a 10-year period (2003–2005 vs. 2015–2017). Additionally, data from Eastern Switzerland (sga) were used to evaluate OS based on the diagnosis-to-surgery interval, with a 15-day cut-off according to SGS recommendations.
The pre-existing dataset of the seven cancer registries contained the following time-points: date of first visit with general practitioner, date of first request for hospital appointment and date of first hospital appointment, date of preoperative needle/core biopsy, date of definitive pathology result/diagnosis, date of admission for the 1st intervention, date of discharge after the 1st intervention, date of the 1st breast surgery, date of the sentinel procedure, date of axillary dissection in the case of separate intervention, start of radiotherapy and end of radiotherapy. No surgery or no surgery information was available for 7.2% of the patients who were excluded from the analysis.
We defined the following time intervals using the time-points that were mostly available:
(a)
Time to diagnosis: time between needle/core biopsy and pathology results.
(b)
Time to surgery: time between pathology results and the time of surgery.
(c)
Time from biopsy to surgery: the time between needle/core biopsy and the time of surgery.
(d)
Time to radiotherapy: the time between surgery and start of radiotherapy.
Exploring the pre-existing dataset of the 7 cancer registries from 2003 to 2005, we identified the following variables for analysis: geography, patients’ age, body mass index (BMI), type of surgery, facility status, insurance status, clinical study inclusion, tumor board presentation, and nationality.
According to the urbanization index by the “Federal Statistical Office 2008,” the cantons were classified as metropolitan (ge, ba, zh) with an index above 90% and rural (ti, sga, vs, gg) with an index below 90%. The urbanization indices for the cantons were as follows: Geneva (99%), Basel (BS: 100%, BL: 92%), Zurich (95%), Ticino (87%), Eastern Switzerland (SG: 67%, AR: 53%, AI: 0%), Valais (57%), and Grisons–Glarus (GR: 49%, GL: 0%) [21]. Patient age was not analyzed as a continuous variable but categorized into young patients (<60 years), elderly patients (≥80 years), and intermediate age groups in 10-year clusters (60–69 years, 70–79 years). For multivariable analyses, age was dichotomized into <70 years and ≥70 years. BMI, calculated as weight (kg) divided by height squared (m2), was categorized into three groups: normal/underweight (<25), overweight (25–29.99), and obese (≥30). Surgical treatment was classified into mastectomy and breast-conserving surgery. Hospital facility type was categorized as private or public, and insurance status was grouped into private, semi-private, and public for 2003–2005 data, while only private and public were distinguished for 2015–2017 data. Patients were also categorized based on clinical trial participation (yes/no) and whether they were presented at a tumor board (yes/no). Nationality was grouped into Swiss and non-Swiss.
In a second step, we amended the study by combining a corresponding dataset of one cancer registry (sga) covering the cantons of St. Gallen and both Appenzell from 2003 to 2005 and 2015 to 2017 for longitudinal and survival analyses. We chose an interval of 10 years between the two time periods.
In order to minimize selection bias, we did not exclude any patients apart of those patients treated with palliative intent and patients with neoadjuvant or adjuvant chemotherapy.

2.4. Statistics

One-way analyses of variance (ANOVA) and univariable linear regression analyses, as well as multivariable regression analyses were used to assess the relationships between the defined time intervals and explanatory variables including urbanity, age, insurance status, hospital type, tumor board presentation, clinical trial inclusion, mastectomy, nationality, and BMI. If a data point was missing, the corresponding observation was excluded from the analysis. The number of missing data points for each time interval is provided in the tables. Differences in the patient survival were assessed via Kaplan–Meier estimates and Cox regression analyses for hazard ratios. With respect to the Swiss Society of Senology recommendation of an interval from biopsy or orientation until the first treatment between 15 and 23 days or 10–15 days, we used a cut-off of 15 days between diagnosis and surgery for overall survival analysis. A p-value less than 0.05 was considered as statistically significant. Confidence intervals (95% CIs) were calculated. All tests were performed via STATA v.18 (STATA Corp, College Station, TX, USA).

3. Results

3.1. Waiting Times in 2003–2005

We identified 2628 women out of 4820 with stage I-III breast cancer who underwent surgery without receiving chemotherapy between 2003 and 2005 for analysis. Patient characteristics are shown in Table 1. The median and mean age were both 67 years (IQR: 58–77). The median and mean BMI were 24.38 (IQR: 21.63–28.40) and 25.51, respectively, although BMI data were only available for 700 patients (26.6%). Breast-conserving surgery was performed in 1309 patients (49.8%), while mastectomy was performed in 528 patients (20.1%). No information on the type of surgery was available for 791 patients (30.1%). Adjuvant radiation therapy was delivered to 1548 patients (58.9%), with missing data for 25 patients (1.0%). Less than half of the patients (45.0%) lived in metropolitan areas. More than half of the patients (57.8%) were discussed at the tumor board, with missing information for 23.5%. Only 1.9% were treated within a clinical trial. Approximately half of the patients had public insurance (47%) and were treated at a public hospital (53%). Eighty-seven percent of the patients were Swiss (Table 1). This section may be divided by subheadings. It should provide a concise and precise description of the experimental results, their interpretation, as well as the experimental conclusions that can be drawn.
The mean interval from biopsy until diagnosis was 4.3 days, from diagnosis until surgery 18.8 days, from biopsy until surgery 26.8 days, and from surgery until radiotherapy was 56.7 days, respectively.
The interval biopsy-to-diagnosis was prolonged in metropolitan areas and in the case of tumor board presentation but was otherwise of equal length among subgroups in the univariable analysis. Further analysis revealed that differences in waiting times, particularly diagnosis-to-surgery and biopsy-to-surgery, were associated with geography, health facility, insurance status, age, tumor board presentation and type of surgery but not with nationality or BMI (Table 2). A difference in the interval biopsy-to-diagnosis was associated with geography and tumor board presentation (Table 2). A difference in the interval surgery-to-radiotherapy was associated with geography, tumor board presentation, insurance status, and hospital facility.
Citizens in metropolitan regions (ge, zh, ba) had a mean waiting time from diagnosis-to-surgery of 22.3 days, whereas those in decentralized regions (sga, gg, vs, ti) had a mean waiting time of 15.7 days (p < 0.001) (Table 2). Radiotherapy initiation was also delayed in metropolitan regions compared with rural regions (59 vs. 53 days, p < 0.001). Box plots of the median time from biopsy-to-surgery for each cancer registry revealed significant disparities in both median intervals and data distributions (Figure 1).
Women with semi-private or private insurance underwent surgery with a mean of 16 days (95% CI: 13.2–19.1) or 24 days (95% CI: 17.0–31.1) after biopsy, respectively, compared with a mean of 30 days (95% CI: 27.1–33.2) for women with basic insurance (p < 0.01). This discrepancy was mirrored in hospital waiting times: the average interval biopsy-to-surgery was 17 days in private clinics, whereas it was 24–34 days in public hospitals (p < 0.001) (Table 2). Interestingly, adjuvant radiotherapy was delayed for women with private insurance (61 vs. 53 days, p < 0.01) and those treated in private hospitals (61 vs. 45–53 days) (p < 0.001) (Table 2).
Examining the four time intervals across different age groups, we found that the biopsy-to-surgery and diagnosis-to-surgery intervals were both age-dependent (p < 0.01), with prolonged durations in elderly patients (Table 2 and Figure 2). The mean interval biopsy-to-surgery ranged from 22 days (95% CI: 19.6–25.2) for women under 60 years old to 39 days (95% CI: 27.0–50.3) for women 80+ years old (p < 0.001) (Figure 2). On the other hand, the average time between surgery and radiotherapy did not vary by age (p = 0.83).
We also evaluated the impact of tumor board presentation on the mean waiting time. According to the univariable analysis, tumor board presentation before surgery significantly prolonged the mean interval biopsy-to-surgery by 9 days (31 vs. 22 days, p < 0.01) (Table 2), whereas presenting patients after surgery had no effect on radiotherapy initiation.
Further analyses of the diagnosis-to-surgery and surgery-to-radiotherapy intervals revealed that patients who underwent mastectomy experienced longer mean waiting times for both surgery (24 vs. 18.6 days, p < 0.01) and radiotherapy (73 vs. 56.3 days, p < 0.001) than did those who underwent breast-conserving surgery (Table 2). No significant influence on the mean waiting time was observed for nationality (diagnosis-to-surgery: 18.5–20.9 days; surgery-to-radiotherapy: 56.5–58.0 days), BMI (diagnosis-to-surgery: 23.3–24.9 days; surgery-to-radiotherapy: 50.9–54.0 days) or participation in a clinical trial (diagnosis-to-surgery: 23.8–27.6 days; surgery-to-radiotherapy: 54–55 days).
Multivariable regression analyses examining the average time interval from diagnosis-to-surgery revealed that residing in a metropolitan area was significantly associated with a longer interval until surgery (Table 3). On average, patients in metropolitan areas waited 9.5 days longer than those in rural areas. Patients aged 70 years and older had slightly longer waiting times than those under 70 years, with an average increase of 3.9 days. Having a private insurance and being treated in a private hospital significantly decreased the mean waiting time by 5.8 days and 7.4 days, respectively. However, presentation at a tumor board did not significantly alter the time between diagnosis and surgery in the multivariable analysis. Undergoing mastectomy was associated with a small increase in waiting time with an average delay of 4.4 days.
A longer mean interval between surgery and radiotherapy was significantly associated with metropolitan residency and undergoing mastectomy in the multivariable analysis (Table 4). On average, patients in metropolitan areas waited 6.3 days longer than those in rural areas. Patients who underwent mastectomy waited 18.4 days longer on average. On the other hand, other factors such as tumor board presentation, age over 70 years, private insurance, or hospital type did not significantly affect the mean time between surgery and radiotherapy.

3.2. Trends in Waiting Times from 2003–2005 to 2015–2017

For longitudinal analysis, we examined data from the cancer registry of Eastern Switzerland (sga) spanning the periods 2003–2005 and 2015–2017, focusing solely on the interval between diagnosis and surgery. We identified 434 out of 871 patients (2003–2005) and 421 out of 1164 patients (2015–2017) with stage I-III breast cancer who underwent surgery without receiving chemotherapy for analysis. The patients’ characteristics are shown in Table 1.
In this population, the mean interval from diagnosis-to-surgery was 21.3 days in 2003–2005 and increased to 31.2 days in 2015–2017 (p = 0.0075). On the other hand, the mean interval surgery-to-radiotherapy remained stable at 52.6 days in 2003–2005 and 53.5 days in 2015–2017 (p = 0.8343). Univariable analysis revealed that patients undergoing mastectomy in 2003–2005 had a weakly significant delay in the interval diagnosis-to-surgery (29.6 vs. 16.5 days; p = 0.0055) but not in 2015–2017 (25.6 vs. 21.6 days; p = NS) (Table 5). There seemed to be an age-dependency, but this difference was not statistically significant (Figure 3). Otherwise, we did not find any significant difference in the interval diagnosis-to-surgery or surgery-to-radiotherapy between the subgroups.

3.3. Survival Differences Due to Waiting Time

For the overall survival analysis, we used data from the cancer registry of Eastern Switzerland (sga) from 2003 to 2005 (N = 434) and 2015 to 2017 (N = 421). Patients were followed up on their vital status at least once per year and the follow-up date corresponds either to the date of death or the date of the last follow-up (either still alive or moved away). On average, patients were followed up for 142 months (cohort 2003–2005) and 80 months (cohort 2015–2017). Patients still alive at the time of data extraction were followed up on average for 234 and 91 months, respectively. We used 15 days as a cut-off on the basis of the recommendations of the SGS. Fifty-seven percent of all patients in 2003–2005 and 34% of all patients in 2015–2017 underwent surgery within 15 days after diagnosis. There was no significant difference in 5-year OS between the two groups of breast cancer patients diagnosed during either time period (Figure 4). However, multivariable Cox regression analysis revealed a significantly greater hazard ratio fr patients aged 70 and above and those who underwent mastectomy (Table 6). Tumor stage and adjuvant endocrine therapy were not analyzed as confounders for OS. When comparing the periods 2003–2005 and 2015–2017, we observed an improvement in the 5-year OS rate, increasing from 76.7% to 88.4%.

4. Discussion

This study, which was based on cancer registries covering 47% of the Swiss population from 2003 to 2005, demonstrated that women with stage I-III breast cancer not treated with chemotherapy generally received timely treatment within 26.8 days post-biopsy and 18.8 days post-diagnosis; however, disparities were evident. Certain groups faced longer waiting times from biopsy until surgery (≥30 days) including women who were living in metropolitan areas, were older than 70 years, had basic insurance and were treated in a public hospital, as well as underwent mastectomy. Mastectomy was significantly correlated with living in rural regions, being older, having public insurance, and being treated at a public hospital, which might explain some of the demographic differences in waiting. Presentation at a tumor board did not alter waiting times in the multivariable analysis in this study. Radiotherapy generally started 8 weeks after surgery, with more delays in metropolitan areas, and among women with private insurance treated at private hospitals and undergoing mastectomy. Over time, the mean interval between diagnosis and surgery increased from 21.3 days in 2003–2005 to 31.2 days in 2015–2017, whereas the mean interval between surgery and radiotherapy was stable at 52.6 days in 2003–2005 and 53.5 days in 2015–2017 in Eastern Switzerland. No significant difference in the 5-year OS was found between patients who underwent surgery within or after 15 days following diagnosis for breast cancer in Eastern Switzerland for either time period. However, the 5-year overall survival rate improved significantly from 76.7% (2003–2005) to 88.4% (2015–2017).

4.1. Timeliness of Surgery in Switzerland in 2003–2005

Our study revealed that for 47% of the Swiss population from 2003 to 2005, the overall mean intervals biopsy-to-surgery and diagnosis-to-surgery were 26.8 days and 18.8 days, respectively. Recommendations for the time between breast cancer diagnosis and surgery vary globally. The SGS advises patient orientation within 5–8 days post-biopsy and initial treatment within 10–15 days thereafter, resulting in 15–23 days from biopsy-to-surgery [19]. The European Society of Breast Cancer Specialists (EUSOMA) suggested a target of 21 days from diagnosis-to-surgery [22,23]. In Canada, programs often aim for 21 to 30 days from core biopsy-to-surgery, whereas the UK NHS aims for a maximum interval of one month (31 days) from the decision to surgery [24,25]. Similarly, the Dutch Breast Cancer Association (NABON) recommends no more than 35 days between diagnosis and surgery in the Netherlands [17]. The US National Quality Measures for Breast Centers (NQMBC) program analyzed data from 2005 to 2008 and reported a median time of 14 working days between needle/core biopsy and surgery for women under 70 years of age, corresponding to a median interval of 18 to 19 days and an estimated mean interval of 20 to 22 days [26]. In the US, Bleicher et al. reported that between 1992 and 2005, 72,586 Medicare patients with breast cancer had a median interval between the first physician visit and surgery of 29 days, increasing from 21 days in 1992 to 32 days in 2005 [4]. In Europe, the median diagnostic interval until surgery has been reported to be 41 days [27] or 34 days [28]. In this context, our results indicate that efficient performance in Switzerland and Eastern Switzerland in 2003–2005 and 2015–2017 was within International and SGS recommendations.

4.2. Disparities in Waiting Times Until Surgery in Switzerland in 2003–2005

Breast cancer surgery waiting times since biopsy differ across patient subgroups [4,27,28,29,30,31]. Our findings indicate that older patients, especially those over 70 years, face significantly longer delays (>28 days, p < 0.001), which is consistent with the findings of a French study by Molinié et al. [28]. Conversely, some studies link longer waiting times to younger patients under 80 years [4], under 70 years [27] or under 50 years [29]. We also found that metropolitan residents experienced extended waits (29 vs. 24 days, p < 0.001), which aligns with the findings of the Bleicher et al. study which reported a 32-day average [4].
Further disparities were observed based on insurance type and treatment setting, with patients holding basic insurance (30 vs. 16–24 days for semi/private, p < 0.01) and those in public hospitals (25–35 vs. 18 days, p < 0.001) encountering more delays. Similarly, Tjoe et al. reported longer waits linked to Medicaid or commercial insurance [29]. In contrast to other studies, we found no significant difference in waiting times between Swiss citizens and non-Swiss citizens. Studies by Bleicher et al. and Webber et al., indicated longer delays for patients of Black and Hispanic ethnicity (each 37 days) or with an immigrant background [4,27,29].
Factors contributing to longer waiting times include comprehensive preoperative evaluations such as MRI, tumor board reviews, and more complex procedures such as mastectomy [27,29,31]. Nessim et al. associated extended waiting times with multiple preoperative visits, additional imaging, and off-site initial imaging (p < 0.05) [31]. Similarly, Webber et al. demonstrated in a large patient cohort study that an increased number of physician visits and breast procedures characterized longer diagnostic intervals [27]. Tjoe et al. reported that MRI prior to surgery increased the time-to-surgery (TTS) to more than 30 days (p < 0.001) [29]. Other studies linked longer TTS with surgery type such as mastectomy and reconstruction [29,32], as well as higher comorbidity and prior healthcare utilization [27,28]. In our study, mastectomy was associated with delays, but tumor board presentations did not significantly affect waiting times when accounting for other factors.

4.3. Waiting Time Until Surgery over Time

Multiple studies have reported a concerning increase in waiting times for breast cancer surgery across different periods: from 1992 to 2005 [4,30], from 2006 to 2019 [32], and from 2013 to 2023 [33]. Tortorello et al., in a study involving 1,435,584 patients in the US, reported that the average TTS increased from 26 days (IQR 16–39) in 2006 to 39 days (IQR 27–56) by 2019 (p < 0.001) [32]. The multivariable linear regression analysis revealed a significant annual increase in the TTS, with an increase of 0.83 days per year (95% confidence interval 0.82–0.85; p < 0.001). The study highlighted that factors such as additional imaging, biopsies, and consultations contributed to these delays [4,27]. Accordingly, our longitudinal analysis of Eastern Switzerland revealed a borderline significant increase in surgery waiting times from 21.3 days in 2003–2005 to 31.2 days in 2015–2017. This suggests that while preoperative diagnostics are essential for ensuring high-quality treatment, they should be conducted in a timely and efficient manner to avoid unnecessary delays [34].

4.4. Timeliness of Radiotherapy in Switzerland in 2003–2005

From 2003 to 2005, our study found that the average time from surgery to the start of radiotherapy was approximately 8 weeks (56.9 days) in Switzerland and approximately 7 weeks (51 days) in Eastern Switzerland. There is no established consensus on the ideal timing for starting postoperative radiotherapy in patients not receiving adjuvant chemotherapy. However, the guidelines from the NHS and NABON recommend beginning radiotherapy within 31 and 35 days, respectively [25,35]. A French study by Bouche et al. reported a mean interval of 52 days from surgery-to-radiotherapy, which is consistent with our findings [36]. Other studies reported a median time to radiotherapy of 53 days between 1986 and 1998 [37], 69 days in 1992 and 88 days in 1998 [38], 43 days in 1992 and 77 days in 2001 [39], 75 days between 1995 and 2003 [30] or 50 days in (interquartile range 41.5–62 days) between 1983 and 2008 [40]. Overall, our findings indicate a timely initiation of postoperative radiotherapy in Switzerland.

4.5. Disparities in Waiting Times Until Radiotherapy in Switzerland in 2003–2005

Our study identified delays in the start of radiotherapy for certain groups: women living in metropolitan areas (59 vs. 54 days), those with private insurance (59 vs. 55 days), patients treated in private hospitals (60 vs. 55 days), and women undergoing mastectomy (73 vs. 56 days). Longer intervals from surgery-to-radiotherapy have been associated with factors such as older age [36,41], more advanced cancer stage [38,41], undergoing mastectomy [41,42], poorer physical health [41], and limited access to radiotherapy facilities [36,41]. Other predictors of delays include late consultation with a radiation oncologist, living far from a radiotherapy center, and residing in a lower socio-economic area [30,38]. The reasons for the observed delays among privately insured patients treated in private hospitals in our study remain unclear.

4.6. Waiting Time Until Radiotherapy over Time

No significant change in waiting time after surgery for radiotherapy was observed in Eastern Switzerland (52.6 days in 2003–2005; 53.5 days in 2015–2017). Earlier studies had generally reported an increase in the interval until 2003 [30,37,38,39]. For example, Mikeljevic et al. reported a significant increase, with the interval growing from 5 weeks in 1986–1988 to 10 weeks in 1997–1998 [37]. In contrast, more recent research suggests efforts to reduce delays, with median intervals of 38 days reported between 2009 and 2011 [41] and 42 days reported between 2005 and 2014 [43], reflecting increased awareness of the importance of timely radiotherapy following surgery.

4.7. Survival Impact of Delays

Numerous studies, including meta-analyses, have shown that delays in breast cancer surgery negatively impact overall OS and disease-specific survival (DSS) [2,9,11,44,45,46,47,48,49]. For example, Bleicher et al. reported that surgery delays affected OS in stage I and II, and DSS specifically in stage I breast cancer, with each delay interval (≤30 days, 31–60 days, 61–90 days, 91–120 days, 121–180 days) resulting in a significant decline in survival rates. However, the difference in 5-year survival difference between patients who underwent surgery within 30 days and those with a 91–120 day delay was relatively small (4.6% and 3.1% for ≤30 days vs. 91–120 days) [2]. A meta-analysis reported a 1.08-fold increase in mortality risk for every four-week delay in surgery [11]. Other studies reported significant survival impact thresholds at different intervals, such as 8 weeks [46,47], 6 weeks [9], 5 weeks [48], or 2 weeks [49]. Zhu et al. examined 5130 breast cancer patients from 2009 to 2017 and showed that those with surgery delays of more than 2 weeks had significantly lower breast cancer-free intervals (HR = 1.80) and OS (HR = 2.07) than those treated within 1 week [49]. However, Tjoe et al. found no increased risk of recurrence or death until the time-to-surgery exceeded 60 days, after adjusting for factors such as age, cancer stage, and triple-negative status [29].
Following the SGS recommendation for a 15–23 day window between biopsy and initial treatment, we used a 15-day cut-off for survival analysis. In our study, no significant difference in the 5-year OS was found between surgery intervals (<15 days vs. ≥15 days) in either the 2003–2005 or the 2015–2017 period. Cox regression analyses revealed significantly higher hazard ratios for patients aged 70 and older, as expected, and for those who underwent mastectomy, which likely reflects a higher tumor stage. Notably, the 5-year OS significantly improved from 76.7% in 2003–2005 to 88.4% in 2015–2017. Recent improvements in breast cancer prognosis may be attributed primarily to two key factors highlighted in the literature: (1) earlier diagnosis and (2) advancements in personalized treatment [50].
Since the pivotal 1996 study by Recht et al., delaying radiotherapy after surgery has been shown to negatively impact local control in breast cancer patients, with higher recurrence rates observed when chemotherapy is given before radiotherapy (14% vs. 5%, p < 0.05) [51]. In patients who did not receive chemotherapy, Ma et al. reported that starting radiotherapy later than 69 days post-surgery significantly reduced disease-free survival (HR 6.430, p = 0.002). The 5-year recurrence rate was 3.0% for those who began radiotherapy within 69 days, whereas it was 12.6% for those who started later [43]. Similarly, Raphael et al. reported that, in stage I or II breast cancer patients who received radiotherapy but no chemotherapy, waiting more than 84 days (12 weeks) to start radiation was linked to worse event-free survival (p = 0.07) [52]. For those undergoing chemotherapy, delays of more than 47 or 42 days after completing chemotherapy were associated with increased in-breast cancer recurrence (p = 0.014) and poorer event-free survival (p = 0.047) [43,52]. These findings support the recommendation to start adjuvant radiotherapy “as soon as reasonably achievable.” Our study indicates that in Switzerland, postoperative radiotherapy is generally initiated within these critical timeframes, supporting favorable patient outcomes.

4.8. Strengths and Limitations of the Study

The strengths of this study include its extensive use of a national database comprising 2628 patients diagnosed with stage I-III breast cancer from seven regional cancer registries, representing nearly half of Switzerland’s population. Additionally, it comprises a longitudinal comparison and survival analysis with up to 20 years of follow-up within one cancer registry in Eastern Switzerland. By leveraging these resources, the study offers distinctive insights into breast cancer management trends and survival in Switzerland and identifies subpopulations at risk of treatment delays.
A key limitation of this study is the decentralized data collection from seven different cancer registries. Without central supervision, data entry varied across registries, resulting in issues such as missing information and inaccuracies. For example, in some cases, the interval from biopsy-to-diagnosis was recorded as zero, indicating that the biopsy date was incorrectly used as the diagnosis date instead of the pathology report date. As a result, the sum of the times biopsy-to-diagnosis and diagnosis-to-surgery differed from the time biopsy-to-surgery. Additionally, the lack of comprehensive data for Switzerland from 2015 to 2017 limits the study’s generalizability. Data were drawn from a single cancer registry covering Eastern Switzerland, which represents only approximately 8% of the population and excludes major metropolitan areas. The follow-up was also quite short for the dataset from 2015 to 2017. Additionally, tumor stage and other treatment regimens (endocrine therapy, chemotherapy, anti-HER2, and anti-CDK4/6 therapies) were not analyzed as confounders for OS. Therefore, OS data should be interpreted with caution, and the longitudinal and survival outcomes may not be generalizable to other study centers or the broader Swiss population. Furthermore, data on performance status, potentially reflecting travel capacity, and financial status were unavailable; however, insurance status (private vs. public) may approximate financial status. Secondary cancers diagnosed before or after breast cancer were not considered, and patients who received chemotherapy were excluded, as the analysis focused on the TTS instead of the time to first therapy, and the interval surgery-to-radiotherapy. Thus, future research should aim to validate these findings with additional and more recent data sources to improve generalizability.

5. Conclusions

This study highlights the timely treatment initiation in 2003–5 (TTS 19–21 days) and the challenges faced by breast cancer patients in Switzerland, revealing disparities in access to care based on factors such as geographic location (22 vs. 16 days), age (25 vs. 16 days), insurance status (22 vs. 18 days), hospital type (21 vs. 15 days), and surgical modality (24 vs. 19 days). While improvements in OS rates over time were noted (5 y OS: 76.7% to 88.4%), rising waiting times for surgery until 2015–17 (TTS 31 days) underscore the need for optimally scheduled interventions such as diagnostic imaging and tests and treatment propositions to ensure timely and equitable access to treatment, ultimately optimizing patient outcomes.

Author Contributions

Conceptualization, C.O., M.E.N.Z., and D.R.Z.; methodology, M.B., M.M., and C.H.; software, M.B. and C.H.; validation, M.B. and C.H.; formal analysis, M.M., C.H., and M.B.; investigation, M.E.N.Z., C.H., and K.R.J.; resources, M.M., C.H., and M.B.; data curation, K.R.J., M.M., and C.H.; writing—original draft preparation, C.O. and M.E.N.Z.; writing—review and editing, C.O., M.M., K.R.J., M.B., and D.R.Z.; visualization, M.E.N.Z., C.O., and M.B.; supervision, D.R.Z. and C.O.; project administration, C.H.; funding acquisition, C.O., D.R.Z., and M.E.N.Z. All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by the Swiss Cancer League (Krebsliga Schweiz), grant number HSR-4663-11-2018.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee in the canton St. Gallen (approval number 2024-02547/EKOS 24/241, 8 April 2008 and 19 December 2024).

Informed Consent Statement

Patient consent was waived due to the use of anonymized cancer registry data (Art. 34 HFG, Art. 37-40 HFV).

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Acknowledgments

We would like to thank the Swiss Cancer League for the grant HSR-4663-11-2018, and the coordinators of the various cancer registries including Silvia E for data nurturing. We are deeply grateful for the significant contributions of our co-author Michel Eric Nicolas Zimmermann, who was closely involved in the early stages of this study. Michel Eric Nicolas Zimmermann sadly passed away during the course of the work, and we honor his memory and scientific input.

Conflicts of Interest

D.Z., C.O., and M.Z. received a grant from the Swiss Cancer League. M.M., M.B., and C.H. work or worked for the Cancer Registry of Eastern Switzerland. R.J. declares no conflicts of interest.

Abbreviations

The following abbreviations are used in this manuscript:
YYears
TTSTime to surgery
CIConfidence interval
HRHazard ratio
baBasel
geGenf
ggGrison
sgaEast Switzerland
tiTicino
vsValais
zhZurich
BSBasel Stadt
BLBasel Land
AIAppenzell Innerrhoden
ARAppenzell Ausserrhoden
SGSt. Gallen
GRGraubuenden
GLGlarus
IQRInterquartile range
EUSOMAEuropean Society of Breast Cancer Specialists
OSOverall survival
BCBreast cancer
ANOVAAnalysis of variance
BMIBody mass index
SGSSwiss Society of Senology

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Radiation 05 00023 g001
Figure 1. Box plots of interval from biopsy-to-surgery for all 7 cancer registries. The plots show the median value, 25% percentile, 75% percentile, range and outliers. The y-axis is cut by 200 days. ba = Basel (BS/BL), ge = Geneva, gg = Grisons-Glarus, sga = Eastern Switzerland (SG/AR/AI), ti = Ticino, vs = Valais, zh = Zurich.
Figure 1. Box plots of interval from biopsy-to-surgery for all 7 cancer registries. The plots show the median value, 25% percentile, 75% percentile, range and outliers. The y-axis is cut by 200 days. ba = Basel (BS/BL), ge = Geneva, gg = Grisons-Glarus, sga = Eastern Switzerland (SG/AR/AI), ti = Ticino, vs = Valais, zh = Zurich.
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Figure 2. Mean time intervals from biopsy-to-surgery (a) and from diagnosis-to-surgery (b) according to age (p < 0.001). The mean values and the 95% confidence intervals are reported.
Figure 2. Mean time intervals from biopsy-to-surgery (a) and from diagnosis-to-surgery (b) according to age (p < 0.001). The mean values and the 95% confidence intervals are reported.
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Figure 3. Mean interval diagnosis-to-surgery according to age in Eastern Switzerland between 2003–2005 (a) and 2015–2017 (b). Reported are mean values and the 95% confidence intervals.
Figure 3. Mean interval diagnosis-to-surgery according to age in Eastern Switzerland between 2003–2005 (a) and 2015–2017 (b). Reported are mean values and the 95% confidence intervals.
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Figure 4. Kaplan–Meier curves for OS for the time periods 2003–2005 (a) and 2015–2017 (b) for patients with the interval diagnosis-to-surgery <15 days versus >15 days in Eastern Switzerland.
Figure 4. Kaplan–Meier curves for OS for the time periods 2003–2005 (a) and 2015–2017 (b) for patients with the interval diagnosis-to-surgery <15 days versus >15 days in Eastern Switzerland.
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Table 1. Patients’ characteristics of the cohorts with the seven cancer registries from 2003 to 2005, Eastern Switzerland from 2003 to 2005 and 2015 to 2017.
Table 1. Patients’ characteristics of the cohorts with the seven cancer registries from 2003 to 2005, Eastern Switzerland from 2003 to 2005 and 2015 to 2017.
Switzerland (7 Registries)
2003–2005
(2628 Patients)		Eastern Switzerland (1 Registry)
2003–2005
(434 Patients)		Eastern Switzerland (1 Registry)
2015–2017
(421 Patients)
Geography
   Rural1445 (55%)434 (100%)421 (100%)
   Metropolitan1183 (45%)0 (0%)0 (0%)
   Missing0 (0%)0 (0%)0 (0%)
Age
   <60760 (29%)103 (24%)135 (32%)
   60–69699 (26.5%)97 (22%)108 (25%)
   70–79648 (24.5%)120 (28%)96 (23%)
   80+521 (20%)114 (26%)82 (20%)
   Missing0 (0%)0 (0%)0 (0%)
   Mean67.10 ±13.3669.45 ±13.8466.66 ± 13.04
   Median67 (58–77)71 (60–80)67 (56–77)
Tumor board
   Yes1518 (58%)148 (34%)258 (61%)
   No492 (19%)72 (17%)5 (1%)
   Missing618 (23%)214 (49%)158 (38%)
Clinical trial
   Yes51 (2%)25 (6%)NA
   No1170 (44.5%)317 (73%)
   Missing1407 (53.5%)92 (21%)
Health insurance
   Private470 (18%)31 (7%)33 (8%)
   Semi-private245 (9%)107 (25%)0 (NA)
   Public1240 (47%)214 (49%)365 (86.55)
   Missing673 (26%)82 (19%)23 (5.5%)
Hospital facility
   Private582 (22%)96 (22%)133 (31.5%)
   Public1392 (53%)309 (71%)278 (66%)
   Missing654 (25%)29 (7%)10 (2.5%)
Nationality
   Swiss2292 (87%)410 (94%)345 (82%)
   Non-Swiss336 (13%)24 (6%)46 (11%)
   Missing0 (0%)0 (0%)30 (7%)
Body Mass Index (BMI)
   <25376 (14.5%)72 (16.5%)NA
   25–29194 (7.5%)46 (10.5%)
   >30130 (5%)25 (6%)
   Missing1928 (73%)291 (67%)
   Mean25.51 ±5.54 25.82 ± 4.89
   Median24.38 (21.63–28.40)24.92 (22.23–28.58)
Type of surgery
   Mastectomy528 (20%)149 (34%)70 (16.5%)
   Breast-conserving surgery1309 (50%)256 (59%)341 (81%)
   Missing791 (30%)29 (7%)10 (2.5%)
Radiotherapy
   Yes1548 (59%)214 (49.5%)281 (67%)
   No1055 (40%)218 (50%)114 (27%)
   Missing25 (1%)2 (0.5%)26 (6%)
T classification
   T11672 (64%)233 (54%)258 (61%)
   T2731 (28%)170 (39%)135 (32%)
   T381 (3%)19 (4%)17 (4%)
   T489 (3%)12 (3%)6 (1%)
   Missing55 (2%)0 (0%)5 (1%)
N Classification
   N01895 (72%)315 (73%)324 (77%)
   N1456 (17%)92 (21%)82 (19%)
   N279 (3%)16 (4%)11 (3%)
   N338 (1%)5 (1%)1 (0%)
   Missing160 (6%)6 (1%)3 (1%)
Tumor grade
   Low728 (28%)94 (22%)106 (25%)
   Intermediate1430 (54%)255 (59%)263 (62%)
   High334 (13%)52 (12%)48 (11%)
   Missing136 (5%)33 (8%)4 (1%)
Estrogen receptor
   Less than 10%193 (7%)30 (7%)20 (5%)
   10–50%167 (6%)26 (6%)5 (1%)
   More than 50%2154 (82%)355 (82%)391 (93%)
   Missing114 (4%)23 (5%)5 (1%)
Progesteron receptor
   Less than 10%631 (24%)102 (24%)77 (18%)
   10–50%602 (23%)86 (20%)60 (14%)
   More than 50%1281 (49%)223 (51%)279 (66%)
   Missing114 (4%)23 (5%)5 (1%)
HER2 receptor status
   Overexpressed or gen amplified218 (8%)29 (7%)23 (5%)
   Not overexpressed or gen not amplified1616 (61%)211 (49%)392 (93%)
   Missing794 (30%)194 (45%)6 (1%)
Received hormonal therapy
   Yes1927 (73%)316 (73%)294 (70%)
   No592 (23%)115 (26%)120 (28%)
   Missing109 (4%)3 (1%)7 (2%)
Table 2. Patients’ characteristics and time intervals according to different variables of all 7 cancer registries in 2003–2005. Reported are mean values.
Table 2. Patients’ characteristics and time intervals according to different variables of all 7 cancer registries in 2003–2005. Reported are mean values.
Time Intervals in Days
Biopsy-to-DiagnosisDiagnosis-to-SurgeryBiopsy-to-SurgerySurgery-to-Radiotherapy
Geography NMeanNMeanNMeanNMean
Metropolitan11646.01109722.39108728.9075059.23
Rural10422.47134615.8797224.3476754.24
Total2206p = 0.0182443p = 0.00012059p = 0.06491517p = 0.0003
Missing422 185 569 1111
Tumor board
Yes12515.37145420.78119430.7591655.70
No4200.6842119.3137322.3226158.42
Total1671p = 0.03541875p = 0.54551567p = 0.01851177p = 0.1365
Missing957 753 1061 1451
Age
<606363.5575015.9362722.4154955.56
60–696004.1868616.9658923.7552256.80
70–795573.9261320.5752428.0537157.60
80+4136.3139424.7031938.667560.07
Total2206p = 0.63322443p = 0.00292059p = 0.00021517p = 0.4519
Missing422 185 569 1111
Insurance
Private4394.4344318.2041424.0432059.00
Semi-private2184.2924311.0021616.1516355.82
Public17775.39115622.41105430.1470854.72
Total1777p = 0.86921842p = 0.00011684p = 0.00131191p = 0.471
Missing851 786 944 1437
Facility
Private5383.2057914.8953619.0142959.55
Public12456.19139121.36124429.9581454.52
Total1783p = 0.13591970p = 0.00051780p = 0.00011243p = 0.0010
Missing845 658 848 1385
Clinical trial
Participant470.745123.824726.604355.09
Non-participant10641.60108627.6398731.9170754.44
Total1111p = 0.81821137p = 0.51881034p = 0.4700750p = 0.8481
Missing1517 1491 1594 1878
Nationality
Swiss19134.49212118.48177926.65129656.48
Foreign2933.3332220.9228027.3922158.06
Total2206p = 0.59962443p = 0.32602059p = 0.83641517p = 0.4136
Missing422 185 569 1111
BMI
<253255.5036323.3131232.5622854.03
25–301752.3119024.4617228.9812853.06
30+1202.5112424.9211429.459250.91
Total620p = 0.5149677p = 0.8771598p = 0.6934448p = 0.6794
Missing2008 1951 2030 2180
Surgery
Mastectomy4747.3652724.0247433.966372.98
Breast-conserving12224.61130818.61122124.42110256.33
Total1696p = 0.20221835p = 0.00651695p = 0.00131165p < 0.0001
Missing932 793 933 1463
Table 3. Multivariable regression analysis for the interval diagnosis-to-surgery of all 7 cancer registries from 2003 to 2005. Days between Diagnosis and Surgery: Number of Observations: 1645, Adjusted R-Squared: 0.025.
Table 3. Multivariable regression analysis for the interval diagnosis-to-surgery of all 7 cancer registries from 2003 to 2005. Days between Diagnosis and Surgery: Number of Observations: 1645, Adjusted R-Squared: 0.025.
Coeff.Std. Err.tp > t95% Confidence Interval
Intercept20.2273.6685.51013.03227.422***
Urban9.4552.1214.4605.29513.617***
Tumor board−4.2972.961−1.450.147−10.1071.512
Age 70+3.8562.0521.880.06−0.1697.882*
Private insurance−5.8182.667−2.180.029−11.05−0.587**
Private hospital−7.3762.969−2.480.013−13.2−1.553**
Mastectomy4.4082.251.960.05−0.0058.822*
* p < 0.1, ** p < 0.05, *** p < 0.001.
Table 4. Multivariable regression analysis for the interval surgery-to-radiotherapy of all 7 cancer registries from 2003 to 2005. Days between Surgery and Radiotherapy: Number of Observations: 1084, Adjusted R-Squared: 0.044.
Table 4. Multivariable regression analysis for the interval surgery-to-radiotherapy of all 7 cancer registries from 2003 to 2005. Days between Surgery and Radiotherapy: Number of Observations: 1084, Adjusted R-Squared: 0.044.
Coeff.Std. Err.tp > t95% Confidence Interval
Intercept52.2122.89818.02046.52657.898***
Urban6.3041.6473.8303.0729.535***
Tumor board−1.7922.343−0.760.445−6.3902.807
Age 70+−0.3281.639−0.20.841−3.5452.888
Private insurance1.3562.0670.660.512−2.7005.412
Private hospital0.5182.2270.230.816−3.8524.889
Mastectomy18.4263.3135.56011.92624.927***
*** p < 0.001.
Table 5. Time intervals according to different variables in Eastern Switzerland in 2003–2005 and 2015–2017. Reported are mean values.
Table 5. Time intervals according to different variables in Eastern Switzerland in 2003–2005 and 2015–2017. Reported are mean values.
Time Intervals in Days
Diagnosis-to-SurgerySurgery-to-Radiotherapy
2003–20052015–20172003–20052015–2017
Tumor board NMeanNMeanNMeanNMean
Yes14721.6825523.448350.7215549.10
No5111.18530.751854.50241.00
Total198p = 0.0115260p = 0.4699101p = 0.4450157p = 0.4975
Missing236 161 333 264
Age
<6010313.9513520.727449.458647.17
60–699718.8210720.866655.156653.02
70–7911817.379423.346553.315443.67
80+8719.357525.72754.292250.19
Total405p = 0.3546411p = 0.2240212p = 0.2615228p = 0.0264
Missing29 10 222 193
Insurance
Private13515.893321.828853.282350.09
Public19718.1035622.4010250.1519548.11
Total332p = 3573389p = 0.8631190p = 0.2053218p = 0.6107
Missing102 32 244 203
Facility
Private9612.9613221.126455.417247.18
Public30918.5827622.7214851.3415548.88
Total405p = 0.0387408p = 0.4102212p = 0.1190227p = 0.5010
Missing29 13 222 194
Clinical trial Not available Not available
Participant2518.202151.19
Non-participant30318.5017552.92
Total328p = 0.9538196p = 0.6642
Missing106 238
Nationality
Swiss38117.2233722.3119252.5818949.13
Foreign2417.834621.292052.452644.15
Total405p = 0.9003383p = 0.7200212p = 0.9751215p = 0.1713
Missing29 38 222 206
BMI Not available Not available
<257216.494450.59
26–304618.932947.31
30+2523.002052.00
Total143p = 0.398693p = 0.5433
Missing291 341
Surgery
Mastectomy14922.076925.55862.25358.33
Breast-conserving25614.5333921.5820452.1922548.16
Total405p = 0.0016408p = 0.1037212p = 0.1094228p = 0.3175
Missing29 13 222 193
Table 6. Multivariable cox regression model for hazard ratios and confidence intervals for OS. Number of Observations: 179.
Table 6. Multivariable cox regression model for hazard ratios and confidence intervals for OS. Number of Observations: 179.
Hazard RatioStd. Err.zp < z95% Confidence Interval
Diagnosis-to-Surgery ≥ 15 days1.0020.1950.010.9920.6851.466
Tumor board1.1000.2770.380.7050.6711.801
Age 70+2.4910.3017.540.0001.9653.158***
Private insurance0.8160.165−1.010.3140.5491.213
Private hospital1.2860.5570.580.5610.5503.006
Mastectomy1.5700.3032.330.0201.0752.291**
** p < 0.05, *** p < 0.001.
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Oehler, C.; Zimmermann, M.E.N.; Mousavi, M.; Joorawon, K.R.; Blum, M.; Herrmann, C.; Zwahlen, D.R. Waiting Times for Surgery and Radiotherapy Among Breast Cancer Patients in Switzerland: A Cancer Registry-Based Cross-Sectional and Longitudinal Analysis. Radiation 2025, 5, 23. https://doi.org/10.3390/radiation5030023

AMA Style

Oehler C, Zimmermann MEN, Mousavi M, Joorawon KR, Blum M, Herrmann C, Zwahlen DR. Waiting Times for Surgery and Radiotherapy Among Breast Cancer Patients in Switzerland: A Cancer Registry-Based Cross-Sectional and Longitudinal Analysis. Radiation. 2025; 5(3):23. https://doi.org/10.3390/radiation5030023

Chicago/Turabian Style

Oehler, Christoph, Michel Eric Nicolas Zimmermann, Mohsen Mousavi, Kattic Ram Joorawon, Marcel Blum, Christian Herrmann, and Daniel Rudolf Zwahlen. 2025. "Waiting Times for Surgery and Radiotherapy Among Breast Cancer Patients in Switzerland: A Cancer Registry-Based Cross-Sectional and Longitudinal Analysis" Radiation 5, no. 3: 23. https://doi.org/10.3390/radiation5030023

APA Style

Oehler, C., Zimmermann, M. E. N., Mousavi, M., Joorawon, K. R., Blum, M., Herrmann, C., & Zwahlen, D. R. (2025). Waiting Times for Surgery and Radiotherapy Among Breast Cancer Patients in Switzerland: A Cancer Registry-Based Cross-Sectional and Longitudinal Analysis. Radiation, 5(3), 23. https://doi.org/10.3390/radiation5030023

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