Factors Affecting Choice of Treatment for Early-Stage Breast Cancer in West Virginia: A 10-Year Experience from a Rural Tertiary Care Center

Recent literature shows changing trends in use of breast conservation surgery (BCS), mastectomy, and contralateral prophylactic mastectomy (CPM) in women with early-stage breast cancer (ESBC). We analyzed factors associated with selection of these treatment modalities in a rural West Virginia tertiary care hospital. We conducted a 10-year analysis of women treated for ESBC at our institution from the institutional cancer registry. Variables were compared between patients choosing BCS versus mastectomy. In women who chose mastectomy, predictors for choice of CPM were also examined. Variables with P < 0.05 on univariate analysis were entered into a multivariate logistic regression model to define independent predictors of treatment choice. The mastectomy rate increased from 18.0 per cent in 2006 to 40.2 per cent in 2013. On multivariate analysis, insurance status (P < 0.001), comorbidities (P = 0.001), and surgeon graduation after 1987—a surrogate for surgeon age—(P = 0.010) predicted receipt of mastectomy. Of those receiving mastectomy, 106 (25.1%) elected CPM. CPM rates increased from 8.0 per cent in 2006 to 45.0 per cent in 2013. Younger age at diagnosis (P < 0.001) and use of preoperative MRI (P = 0.012) independently predicted use of CPM versus unilateral mastectomy. Rates of mastectomy and CPM in ESBC have increased in West Virginia over time. Independent predictors of selecting mastectomy over BCS included insurance status, surgeon age, and associated comorbidities. Younger patients and patients receiving preoperative MRI were more likely to choose CPM. Awareness of these factors will aid in counseling women with ESBC and allow clinicians to address potential biases or disparities that may affect treatment choices. Further prospective study of these findings is warranted.

Download Full-text

Outcomes after Mastectomy and Lumpectomy in Octogenarians and Nonagenarians with Early-Stage Breast Cancer

The American Surgeon ◽

10.1177/000313481708300842 ◽

2017 ◽

Vol 83 (8) ◽

pp. 887-894 ◽

Cited By ~ 2

Author(s):

Ameliay Merrill ◽

Doris R. Brown ◽

Heidi D. Klepin ◽

Edward A. Levine ◽

Marissa Howard-Mcnatt

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Early Stage ◽

Clinical Stage ◽

Univariate Analysis ◽

Local Treatment ◽

Breast Conservation ◽

Early Stage Breast Cancer ◽

Risk Of Death ◽

Increased Risk

Prospective studies have shown equal outcomes after mastectomy or breast conservation in patients with invasive breast cancer; however, many of these studies excluded elderly patients. We identified patients in their eighties and nineties with clinical stage 0 to II breast cancer undergoing mastectomy or lumpectomy with or without radiation from the prospective sentinel lymph node database at Wake Forest Baptist Health and analyzed their treatment and survival. Of 92 patients, 24 (26.1%) underwent mastectomy, 22 (23.9%) lumpectomy with radiation, and 46 (50.0%) lumpectomy alone. Significant differences were noted in tumor size (P = 0.018), nodal status (P = 0.013), and stage (P = 0.011) between the groups. Only 7.6 per cent of patients had chemotherapy, whereas 51.1 per cent took antiestrogen therapy. Recurrence occurred in 11 patients. In univariate analysis, overall survival did not differ by surgery. Age was the only factor that increased risk of death (HR = 1.19, P = 0.028). In this age group, neither tumor factors nor the type of local treatment significantly influenced overall survival. Octogenarians and nonagenarians with early-stage breast cancer undergoing breast-conserving surgery with or without radiation have equivalent survival to patients having a mastectomy.

Download Full-text

Disparities in Rural Breast Cancer Care: Factors Affecting Choice of Breast Reconstruction in a West Virginia Tertiary Care Hospital

The American Surgeon ◽

10.1177/000313481708300727 ◽

2017 ◽

Vol 83 (7) ◽

pp. 717-721 ◽

Cited By ~ 1

Author(s):

Tyler L. Holliday ◽

Patrick D. Suggs ◽

Stephanie N. Thompson ◽

Bryan K. Richmond

Keyword(s):

Breast Cancer ◽

West Virginia ◽

Breast Reconstruction ◽

Rural Population ◽

Early Stage ◽

Tertiary Care ◽

The United States ◽

Care Hospital ◽

Unilateral Breast Cancer ◽

Insurance Type

The decision to pursue immediate postmastectomy breast reconstruction (IBR) is not uniform across all groups of women in the United States. We sought to investigate if the challenges of caring for a socioeconomically and geographically challenged rural population affected the incidence of IBR and to identify predictive factors of IBR in this population. Using our institution's cancer registry, we conducted a 10-year review of women with early-stage, unilateral breast cancer who received mastectomy. Demographics, insurance status, comorbidities, and surgeon graduation year were compared for patients receiving IBR versus no reconstruction. Variables with P < 0.05 on univariate analysis were included into a multivariate logistic regression model to determine independent predictors of IBR. From 2006 to 2015, 53/423 (12.5%) patients underwent IBR. On multivariate analysis, three factors independently predicted the decision to undergo IBR: age (P = 0.004), insurance type (P = 0.034), and use of contralateral prophylactic mastectomy (CPM, P < 0.001). Our data indicate that age, insurance type, and utilization of CPM influence the decision to pursue reconstruction. Additionally, the rate of IBR was found to be much lower in our West Virginia population than reported nationally, suggesting disparities in the care of women with early-stage, unilateral breast cancer in a rural population, even in a tertiary care environment.

Download Full-text

How much is too much? Multidisciplinary management of elderly early-stage breast cancer (BC) patients.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e12525 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e12525-e12525

Author(s):

Elizabeth R. Berger ◽

Srinivasa Sevilimedu Veeravalli ◽

Monica Morrow ◽

Alexandra S. Heerdt

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Early Stage ◽

Univariate Analysis ◽

Multivariable Analysis ◽

Breast Conservation ◽

Treatment Decision ◽

Early Stage Breast Cancer ◽

The Impact ◽

Breast Procedure

e12525 Background: Optimal approach to early-stage breast cancer (BC) management in women ≥70y is unclear. Studies have demonstrated improved local control but no survival advantage with use of radiation therapy (RT) after breast-conservation therapy (BCT). The impact on survival of other management decisions, including breast procedure, axillary staging (AS), systemic treatment, and patient comorbidities is unknown. We evaluate the effect of each treatment decision on overall survival (OS), disease-free survival (DFS), and breast-cancer specific survival (BCSS). Methods: Patients age ≥70y with cT1N0/ER+/HER2- tumors undergoing surgery from 2011-2013 were identified from a prospectively maintained, single-institution database. Clinicopathologic features were evaluated. 10-year estimated mortality from comorbidity was calculated using a Suemoto index (SI). Univariate and multivariable associations were assessed using Cox modeling. Kaplan-Meier method was used to estimate OS and DFS. Results: 338 patients were identified: 312 (92%) underwent BCT; 26 (8%) had mastectomy. Median age was 75.5y (70-101); median tumor size was 1.0cm (0.1-1.9); median SI was 42.5(22-99). With a median follow-up of 60 mos, 25 patients died—1 from BC, for an OS rate of 92.8% and BCSS of 99.7%. 9 patients developed a locoregional recurrence and 1 developed distant recurrence, representing a 5-year DFS rate of 97.8%. There were no differences in DFS by age groups (≤75, 76-80, > 80; p = 0.1). On univariate analysis, DFS did not vary by age, breast procedure, or receipt of chemotherapy. It was improved in those who had AS and a lower SI (p < 0.01). OS was better in those patients who had AS, had recurrence score performed and had radiation therapy, reflecting lower SI. On multivariable analysis, lack of AS (HR 10.5, p < 0.01) and higher SI (HR 1.03, p < 0.01) were the only variables associated with worse OS. Lack of AS became non-significant in those > 80y. No treatment decision led to improved BCSS. When comparing patients with local or systemic recurrence vs those without recurrence, there was no difference in OS (p = 0.4) or BCSS (p = NS). Conclusions: Decisions in early-stage BC in the elderly are complex due to competing morbidities. While DFS and OS may vary based on treatment variables, no specific care component affected BCSS. Treatment discussions in elderly BC patients should emphasize the risks/benefits of each care component, taking into consideration the patient’s comorbidities and allowing for the patient’s understanding of outcomes and quality of life.

Download Full-text