Planned Interim Analysis Results from a Prospective Multicenter Single-Arm Cohort Study of Patients Receiving Endocrine Therapy but Not Radiotherapy after Breast-Conserving Surgery for Early-Stage Breast Cancer with Favorable Biologic Features

6558 Background: We studied care for early-stage breast cancer in Appalachia, a region with health infrastructure, socioeconomic (SES) and geographic disparities. Methods: Cases of stage I-III breast cancer diagnosed 2006-2008 were identified from cancer registries of KY, NC, OH, and PA and linked to Medicare data. Guideline concordance was studied in eligible groups, as follows: endocrine therapy for hormone receptor positive cancer (n=1429); and radiation (RT) use after breast conserving surgery (BCS) divided into two groups - age 70 years and older with ER/PR+, <2 cm, node negative tumors where it may have been acceptable to forgo RT (OptRT, n=1108) and all other cases (IndRT, n=1422). Multivariate (MV) and univariate analyses were performed. Covariates included age, state, Appalachian Regional Commission (ARC) economic status, Commission of Cancer (CoC) status, state, access to care, number of beds, surgery facility ownership, volume, and chemotherapy/radiation offered, provider graduation year and volume, Charlson comorbidity, diagnosis year, Medicaid/Medicare dual status, histology, tumor size, tumor sequence, positive lymph nodes, ER/PR status, stage, herceptin use, and BCS/mastectomy indicator. Results: Mean age was 74 years and 97% were white. Guideline-concordance was 76% for endocrine therapy, 83% for IndRT, and 77% for OptRT. Younger age predicted higher concordance in all groups. Endocrine therapy use was lower in NC vs PA (OR 0.60; 95% CI 0.41-0.88) and greater for cases whose provider graduated in years 1984-1988, vs. 1989+ (1.55; 1.06-2.29). In IndRT, provider volume in the 3rdquartile vs. highest quartile predicted increased radiation use (2.36; 1.46-3.81). In OptRT, less receipt of radiation was predicted by residence in NC vs. PA (0.26; 0.18-0.48), and competitive ARC class vs. transitional (0.60; 0.36-0.99). Conclusions: Within Appalachia, there are SES and provider characteristics that are associated with use of guideline concordant care.

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Impact of chemotherapy, radiotherapy, and endocrine therapy on sick leave in women with early-stage breast cancer during a 5-year period: a population-based cohort study

Breast Cancer Research and Treatment ◽

10.1007/s10549-020-05720-4 ◽

2020 ◽

Vol 182 (3) ◽

pp. 699-707 ◽

Cited By ~ 1

Author(s):

Anna Plym ◽

Anna L. V. Johansson ◽

Hannah Bower ◽

Anna-Karin Wennstig ◽

Irma Fredriksson ◽

...

Keyword(s):

Breast Cancer ◽

Cohort Study ◽

Sick Leave ◽

Endocrine Therapy ◽

Early Stage ◽

Population Based ◽

Early Stage Breast Cancer

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Associated Factors and Survival Outcomes for Breast Conserving Surgery versus Mastectomy among New Zealand Women with Early-Stage Breast Cancer

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052738 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2738

Author(s):

Mohammad Shoaib Abrahimi ◽

Mark Elwood ◽

Ross Lawrenson ◽

Ian Campbell ◽

Sandar Tin Tin

Keyword(s):

Breast Cancer ◽

Regression Analysis ◽

New Zealand ◽

Early Stage ◽

Breast Conserving Surgery ◽

Early Stage Breast Cancer ◽

Clinical Factors ◽

Breast Cancer Specific Mortality ◽

Specific Mortality ◽

Cancer Specific Mortality

This study aimed to investigate type of loco-regional treatment received, associated treatment factors and mortality outcomes in New Zealand women with early-stage breast cancer who were eligible for breast conserving surgery (BCS). This is a retrospective analysis of prospectively collected data from the Auckland and Waikato Breast Cancer Registers and involves 6972 women who were diagnosed with early-stage primary breast cancer (I-IIIa) between 1 January 2000 and 31 July 2015, were eligible for BCS and had received one of four loco-regional treatments: breast conserving surgery (BCS), BCS followed by radiotherapy (BCS + RT), mastectomy (MTX) or MTX followed by radiotherapy (MTX + RT), as their primary cancer treatment. About 66.1% of women received BCS + RT, 8.4% received BCS only, 21.6% received MTX alone and 3.9% received MTX + RT. Logistic regression analysis was used to identify demographic and clinical factors associated with the receipt of the BCS + RT (standard treatment). Differences in the uptake of BCS + RT were present across patient demographic and clinical factors. BCS + RT was less likely amongst patients who were older (75+ years old), were of Asian ethnicity, resided in impoverished areas or areas within the Auckland region and were treated in a public healthcare facility. Additionally, BCS + RT was less likely among patients diagnosed symptomatically, diagnosed during 2000–2004, had an unknown tumour grade, negative/unknown oestrogen and progesterone receptor status or tumour sizes ≥ 20 mm, ≤50 mm and had nodal involvement. Competing risk regression analysis was undertaken to estimate the breast cancer-specific mortality associated with each of the four loco-regional treatments received. Over a median follow-up of 8.8 years, women who received MTX alone had a higher risk of breast cancer-specific mortality (adjusted hazard ratio: 1.38, 95% confidence interval (CI): 1.05–1.82) compared to women who received BCS + RT. MTX + RT and BCS alone did not have any statistically different risk of mortality when compared to BCS + RT. Further inquiry is needed as to any advantages BCS + RT may have over MTX alternatives.

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Pre-diagnosis and early post-diagnosis dietary soy isoflavone intake and survival outcomes: A prospective cohort study of early stage breast cancer survivors

Cancer Treatment and Research Communications ◽

10.1016/j.ctarc.2021.100350 ◽

2021 ◽

Vol 27 ◽

pp. 100350

Author(s):

Suzanne C. Ho ◽

Winnie Yeo ◽

William Goggins ◽

Carol Kwok ◽

Ashley Cheng ◽

...

Keyword(s):

Breast Cancer ◽

Cohort Study ◽

Cancer Survivors ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Breast Cancer Survivors ◽

Early Stage ◽

Early Stage Breast Cancer ◽

Survival Outcomes ◽

Soy Isoflavone

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Association of Intraoperative Radiotherapy in the Treatment of Early-Stage Breast Cancer With Minor Surgical Site Complications in Oncoplastic Breast-Conserving Surgery

JAMA Surgery ◽

10.1001/jamasurg.2017.3129 ◽

2017 ◽

Vol 152 (12) ◽

pp. 1180 ◽

Cited By ~ 2

Author(s):

Angelena Crown ◽

Janie W. Grumley

Keyword(s):

Breast Cancer ◽

Early Stage ◽

Intraoperative Radiotherapy ◽

Breast Conserving Surgery ◽

Early Stage Breast Cancer ◽

Surgical Site Complications

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Use of breast-conserving surgery for treatment of stage I and stage II breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.1998.16.1.101 ◽

1998 ◽

Vol 16 (1) ◽

pp. 101-106 ◽

Cited By ~ 67

Author(s):

E Guadagnoli ◽

J C Weeks ◽

C L Shapiro ◽

J H Gurwitz ◽

C Borbas ◽

...

Keyword(s):

Breast Cancer ◽

Cohort Study ◽

Surgical Treatment ◽

Rural Areas ◽

Medical Records ◽

Retrospective Cohort ◽

Early Stage ◽

Breast Conserving Surgery ◽

Teaching Hospitals ◽

Type Of Surgery

PURPOSE To assess the use of breast-conserving surgery in two states reported to differ with respect to surgical treatment of breast cancer. METHODS A retrospective cohort study based on data collected from medical records and patients was performed among 1,514 patients diagnosed with early-stage breast cancer in Massachusetts and 1,061 patients in Minnesota. Patients were identified at 18 randomly selected hospitals in Massachusetts and at 30 hospitals in Minnesota. The rate of breast-conserving surgery in both states and the correlates of breast-conserving surgery among women eligible for the procedure were determined. RESULTS The rate of breast-conserving surgery in both states was much higher than previously reported. Among those eligible for the procedure, nearly 75% underwent breast-conserving surgery in Massachusetts and nearly half did so in Minnesota. Significantly (P < .003) more women who underwent mastectomy in Minnesota (27%) than in Massachusetts (15%) reported that their surgeon did not discuss breast-conserving surgery with them. Among women who underwent mastectomy and who reported being informed of both surgical alternatives, more women (P < .001) in Minnesota (74%) than in Massachusetts (62%) said they ultimately chose mastectomy because their surgeon recommended it. In Massachusetts, women treated at teaching hospitals were twice as likely as other women to undergo breast-conserving surgery. In Minnesota, women over age 70 and those who lived in rural areas were less likely than other women to undergo breast-conserving surgery. CONCLUSION Although the rate of breast-conserving surgery in each state was higher than expected based on earlier reports, the rates differed considerably between states. Additional studies are needed to determine whether variation in practice between geographic areas is due to differences in patients' preferences and values or to surgeons' propensity for one type of surgery based on where they practice.

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