The implication of a continuous relationship between start of radiotherapy and local recurrence is that there is no "safe" threshold in terms of waiting time and that radiotherapy should therefore be started as soon as possible, say the authors.

The cost of increasing capacity to ensure uniformly short waiting times could be substantial and would need to be weighed against the small absolute benefit in local recurrence, they add. But, given the known negative impact of local recurrence on overall survival, and the large numbers of women treated with radiotherapy for breast cancer, it seems appropriate to consider whether this is a price we should be prepared to pay, they conclude.

Minimising delay improves outcomes, so investment and planning are needed, say Ruth Jack and Lars Holmberg from King's College London, in an accompanying editorial.

Healthcare providers need to assess where potential delays are occurring and ensure that they are reduced, as well as ensuring equal opportunities in accessing good care, they write. However they suggest that, if substantial investment is needed, the modest effects seen in this study would have to be weighed against other opportunities and priorities in cancer care.

Source: BMJ-British Medical Journal