New Study Co-Authored by XpediteMD CEO Reveals Urgent Risks of Delays in Breast Cancer Surgery

Study Title: Breast Cancer Upstaging Risk and In Vivo Tumor Growth Rates Associated with Preoperative Delays
Journal: Annals of Surgical Oncology (Published July 23, 2025)
Lead Authors Include: Dennis R. Holmes, MD, FACS (CEO, XpediteMD)
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Why This Study Matters for Breast Cancer Outcomes and Navigation Programs

Delays in cancer care are not just administrative setbacks—they are clinical risks. In this landmark study, co-authored by Dennis Holmes, MD, FACS, a nationally recognized breast surgical oncologist and CEO of XpediteMD, researchers quantify how even brief surgical delays can result in measurable tumor progression and upstaging in breast cancer patients.

The findings provide clinical validation for XpediteMD’s mission: to reduce time to treatment and prevent avoidable worsening of disease through AI-supported navigation and workflow automation.

Key Findings from Over 1 Million Patient Records

The study evaluated more than 1,018,000 breast cancer patients treated with surgery-first approaches between 2010 and 2020. Researchers compared clinical and pathological staging to determine:

• Overall Upstaging Rates:
  • Tumor (T-stage): 11.5%
  • Lymph Node (N-stage): 14.1%
• Every 30-Day Delay Increased Risk of Upstaging:
  • Ductal Carcinoma In Situ (DCIS): +11%
  • Small tumors (cT1): +13%
  • Larger tumors (cT2): +18%
• By Tumor Phenotype:
  • Triple-negative tumors: OR 1.21
  • Hormone receptor-positive (HR+): OR 1.13
  • HER2-positive: OR 1.09
• Growth Velocity:
  • Some aggressive tumors grew 1 mm every 1–2 days, with triple-negative tumors growing fastest.

“We knew delay was dangerous, but this is one of the most detailed models to quantify the actual pace of tumor progression—and how much harm a delay can cause,” said Dr. Holmes.

Clinical & Operational Implications

This study sheds light on two key dynamics contributing to stage migration:

1. Clinical Understaging: Imaging may underestimate actual disease burden at the time of diagnosis.
2. Growth During Delay: Tumors can significantly grow and spread even over short time periods while patients wait for surgery.

The combination of both effects underscores the urgency of fast, coordinated treatment pathways—especially for high-risk subtypes like triple-negative breast cancer.

What It Means for Cancer Programs and Navigation Tools

For cancer centers and surgery practices, the study is a call to action:

• Accelerating the timeline from diagnosis to surgery can reduce the risk of disease progression.
• Navigation tools must prioritize timeliness—not just education or documentation.
• Automated workflow platforms like XpediteMD are well-positioned to bridge the gap between diagnosis and treatment.

XpediteMD Is Built to Prevent These Delays

At XpediteMD, we work with practices and health plans to streamline navigation workflows, eliminate delays, and reduce time to treatment. This study further supports the role of tech-enabled navigation in not only improving patient experience, but also preserving clinical outcomes.

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