Factors Predicting the Use of Breast-Conserving Therapy in Stage I and II Breast Carcinoma

2001 ◽  
Vol 19 (8) ◽  
pp. 2254-2262 ◽  
Author(s):  
Monica Morrow ◽  
Julia White ◽  
Jennifer Moughan ◽  
Jean Owen ◽  
Thomas Pajack ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Local Therapy ◽  
Breast Conserving Surgery ◽  
Breast Conserving Therapy ◽  
Stage I ◽  
Tumor Characteristics ◽  
Convenience Sample ◽  
Intraductal Component ◽  
Pathology Reports ◽  
Tumor Registries

PURPOSE: To define patterns of care for the local therapy of stage I and II breast cancer and to identify factors used to select patients for breast-conserving therapy (BCT). PATIENTS AND METHODS: A convenience sample of 16,643 patients with stage I and II breast cancer treated in 1994 was obtained from hospital-based tumor registries. Histologic variables were determined from original pathology reports. RESULTS: BCT was performed in 42.6% of patients. Multivariate analysis demonstrated that living in the Northeast United States (odds ratio [OR], 2.48; 95% confidence interval [CI], 2.16 to 2.84), having a clinical T1 tumor (OR, 2.51; 95% CI, 2.27 to 2.78), and having a tumor without an extensive intraductal component (OR, 2.07; 95% CI, 1.81 to 2.37) were the strongest predictors of breast-conserving surgery. Radiation therapy was given to 86% of patients who had breast-conserving surgery. Age less than 70 years was the most significant predictor of receiving radiation (OR, 2.11; 95% CI, 1.77 to 2.25). Tumor variables did not correlate with the use of radiation, but favorable tumor characteristics were associated with the use of breast-conserving surgery. CONCLUSION: Despite strong evidence supporting the use of BCT, the majority of women continue to be treated with mastectomy. Predictors of the use of BCT do not correspond to those suggested in guidelines.

scholarly journals Accelerated Partial Breast Irradiation as an Alternative to Whole-Breast Irradiation in Breast-Conserving Therapy for Early-Stage Breast Cancer

2005 ◽  
Vol 1 (1) ◽  
pp. 59-71
Author(s):  
Timothy M Pawlik ◽  
Henry M Kuerer
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Local Therapy ◽  
Breast Conserving Surgery ◽  
Breast Conserving Therapy ◽  
Early Stage Breast Cancer ◽  
Accelerated Partial Breast Irradiation ◽  
Partial Breast Irradiation ◽  
Whole Breast Irradiation ◽  
Breast Irradiation

Breast-conserving therapy has been established as a standard treatment for women with early-stage breast cancer. Whole-breast irradiation has traditionally been utilized to consolidate local therapy following conservative surgery. Recently, the need for whole-breast irradiation after breast-conserving surgery has become controversial, with some investigators advocating accelerated partial breast irradiation as an alternative. Accelerated partial breast irradiation is delivered over a shorter period and only to a portion of the breast. This review will examine the emerging role of accelerated partial breast irradiation in the treatment of early-stage breast cancer and review the biologic rationale for, techniques of, and limitations of partial breast irradiation following breast-conserving surgery.

scholarly journals Breast Cancer Among the Oldest Old: Tumor Characteristics, Treatment Choices, and Survival

2010 ◽  
Vol 28 (12) ◽  
pp. 2038-2045 ◽  
Author(s):  
Mara A. Schonberg ◽  
Edward R. Marcantonio ◽  
Donglin Li ◽  
Rebecca A. Silliman ◽  
Long Ngo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Oldest Old ◽  
Age Groups ◽  
Breast Conserving Surgery ◽  
Stage I ◽  
Tumor Characteristics ◽  
Data Set ◽  
Younger Women ◽  
The Impact

Purpose Few data are available on breast cancer characteristics, treatment, and survival for women age 80 years or older. Patients and Methods We used the linked Surveillance, Epidemiology and End Results-Medicare data set from 1992 to 2003 to examine tumor characteristics, treatments (mastectomy, breast-conserving surgery [BCS] with radiation therapy or alone, or no surgery), and outcomes of women age 80 years or older (80 to 84, 85 to 89, ≥ 90 years) with stage I/II breast cancer compared with younger women (age 67 to 79 years). We used Cox proportional hazard models to examine the impact of age on breast cancer–related and other causes of death. Analyses were performed within stage, adjusted for tumor and sociodemographic characteristics, treatments received, and comorbidities. Results In total, 49,616 women age 67 years or older with stage I/II disease were included. Tumor characteristics (grade, hormone receptivity) were similar across age groups. Treatment with BCS alone increased with age, especially after age 80. The risk of dying from breast cancer increased with age, significantly after age 80. For stage I disease, the adjusted hazard ratio of dying from breast cancer for women age ≥ 90 years compared with women age 67 to 69 years was 2.6 (range, 2.0 to 3.4). Types of treatments received were significantly associated with age and comorbidity, with age as the stronger predictor (26% of women age ≥ 80 years without comorbidity received BCS alone or no surgery compared with 6% of women age 67 to 79 years). Conclusion Women age ≥ 80 years have breast cancer characteristics similar to those of younger women yet receive less aggressive treatment and experience higher mortality from early-stage breast cancer. Future studies should focus on identifying tumor and patient characteristics to help target treatments to the oldest women most likely to benefit.

141 Breast-conserving therapy (BCT) in stage I–II synchronous bilateral breast cancer (SBBC)

1995 ◽  
Vol 32 ◽  
pp. 211 ◽  
Author(s):  
Smitha V. Gollamudi ◽  
Rebecca S. Gelman ◽  
Gloria Peiro ◽  
Lindsey Schneider ◽  
James L. Connolly ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bilateral Breast Cancer ◽  
Breast Conserving Therapy ◽  
Stage I ◽  
Synchronous Bilateral Breast Cancer

Mastectomy versus breast-conserving therapy in the treatment of stage I and II carcinoma of the breast: a randomized trial at the National Cancer Institute.

1992 ◽  
Vol 10 (6) ◽  
pp. 976-983 ◽  
Author(s):  
A S Lichter ◽  
M E Lippman ◽  
D N Danforth ◽  
T d'Angelo ◽  
S M Steinberg ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Randomized Study ◽  
Breast Conservation ◽  
Disease Free Survival ◽  
Excisional Biopsy ◽  
Breast Conserving Therapy ◽  
Stage I ◽  
Breast Cancer Patients ◽  
Tumor Bed ◽  
Local Regional Control

PURPOSE Mastectomy versus excisional biopsy (lumpectomy) plus radiation for the treatment of stage I and II breast cancer was compared in a prospective randomized study. PATIENTS AND METHODS From 1979 to 1987, 247 women were randomized and 237 were treated on this study. All patients received a full axillary dissection and all node-positive patients received adjuvant chemotherapy with cyclophosphamide and doxorubicin. Radiation consisted of external-beam therapy to the whole breast with or without supraclavicular nodal irradiation followed by a boost to the tumor bed. RESULTS The minimum time on the study was 18 months and the median time on the study was 68 months. No differences in overall survival or disease-free survival were observed. Actuarial estimates at 5 years showed that 85% of mastectomy-treated patients were alive compared with 89% of the lumpectomy/radiation patients (P2 = .49; 95% two-sided confidence interval [CI] about this difference, 0% to 9% favoring lumpectomy plus radiation). The probability of failure in the irradiated breast was 12% by 5 years and 20% by 8 years according to actuarial estimates. Of 15 local breast failures, 14 were treated with and 12 were controlled by mastectomy; the ultimate local-regional control was similar in both arms of the trial. CONCLUSION These data add further weight to the conclusion that breast conservation using lumpectomy and breast irradiation is equivalent to mastectomy in terms of survival and ultimate local control for stage I and II breast cancer patients.

Mastectomy or Lumpectomy? Helping Women Make Informed Choices

1999 ◽  
Vol 17 (6) ◽  
pp. 1727-1727 ◽  
Author(s):  
Timothy Whelan ◽  
Mark Levine ◽  
Amiram Gafni ◽  
Kenneth Sanders ◽  
Andrew Willan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Clinical Stage ◽  
Treatment Options ◽  
Breast Conserving Surgery ◽  
Breast Conserving Therapy ◽  
Average Score ◽  
Simple Method ◽  
The Impact ◽  
Decision Board

PURPOSE: To develop an instrument to help clinicians inform their patients about surgical treatment options for the treatment of breast cancer and to evaluate the impact of the instrument on the clinical encounter. METHODS: We developed an instrument, called the Decision Board, to present information regarding the benefits and risks of breast-conserving therapy (lumpectomy plus radiation therapy) and mastectomy to women with early-stage breast cancer to enable them to express a preference for the type of surgery. Seven surgeons from different communities in Ontario administered the instrument to women with newly diagnosed clinical stage I or II breast cancer over an 18-month period. Patients and surgeons were interviewed regarding acceptability of the instrument. The rates of breast-conserving surgery performed by surgeons before and after the introduction of the instrument were compared. RESULTS: The Decision Board was administered to 175 patients; 98% reported that the Decision Board was easy to understand, and 81% indicated that it helped them make a decision. The average score on a true/false test of comprehension was 11.8 of 14 (84%) (range, 6 to 14). Surgeons found the Decision Board to be helpful in presenting information to patients in 91% of consultations. The rate of breast-conserving surgery decreased when the Decision Board was introduced (88% v 73%, P = .001) CONCLUSION: The Decision Board is a simple method to improve communication and facilitate shared decision making. It was well accepted by patients and surgeons and easily applied in the community.

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