Prior DCIS and overall mortality in women with stage I breast cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e12593-e12593
Author(s):  
Rebecca A. Nelson ◽  
Lily L. Lai ◽  
Joanne E. Mortimer ◽  
Enrique Soto Perez De Celis ◽  
Rowan T. Chlebowski ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Invasive Breast Cancer ◽  
Tumor Grade ◽  
Breast Cancer Diagnosis ◽  
Stage I ◽  
Factors Associated ◽  
Breast Cancer Specific Mortality ◽  
Specific Mortality ◽  
Cancer Specific Mortality ◽  
Overall Mortality

e12593 Background: Whether a prior diagnosis of ductal carcinoma in situ (DCIS) impacts women later diagnosed with invasive breast cancer is unclear. If localized breast cancer following DCIS is more aggressive than localized breast cancer alone, this could inform therapy decisions. To our knowledge, no study has examined the impact of prior DCIS on overall mortality in women with stage I invasive breast cancer. The study objective was to determine if overall mortality for women with stage I breast cancer with prior DCIS is different from those with stage I disease without prior DCIS. Our hypothesis was that women with prior DCIS would have higher mortality compared to those without prior DCIS. Methods: 302,484 patients with stage I cancer diagnosed from 1998 to 2016 were ascertained from SEER. Of these, 5,011 (1.7%) had prior DCIS. Patients with DCIS were matched 1:2 to women with no prior DCIS based on age, year of diagnosis, race/ethnicity, marital status, and invasive breast cancer characteristics including histology, tumor grade, tumor size, T stage, N stage, ER/PR status, surgery type, radiation, and chemotherapy status. The primary study outcome was overall mortality. Cox proportional hazards models were used to compute hazard ratios (HR) and 95% confidence intervals (CI). Results: Cases and controls had similar demographics. Compared to women with stage I breast cancer without prior DCIS, overall mortality was statistically significantly lower in women with stage I breast cancer with prior DCIS (hazard ratio [HR] 0.89 95% confidence interval [CI]0.80-0.98). Other factors associated with overall mortality were bilateral mastectomy (adjusted HR: 0.62; 95% CI: 0.49-0.78), radiation therapy (adjusted HR: 0.64; 95% CI: 0.56-0.75) and chemotherapy (adjusted HR: 0.85; 95% CI: 0.72-0.99). Factors associated with higher overall mortality included age (trend p < 0.001), tumor grade (trend p = 0.003), and negative PR receptor status (adjusted HR: 1.29; 95% CI: 1.13-1.45). Breast cancer specific mortality, however, was statistically significantly higher in women with prior DCIS to their breast cancer diagnosis compared to women without prior DCIS to their breast cancer diagnosis (HR 1.24 95% CI 1.01-1.52). Conclusions: Contrary to our hypothesis, women with prior DCIS and subsequent stage I breast cancer have lower overall mortality compared to matched controls with stage I breast cancer without prior DCIS. In contrast, those with prior DCIS have higher breast cancer specific mortality than those without prior DCIS. Reasons for this discrepancy are unknown, but since DCIS is most commonly diagnosed on mammogram, differences may be related to sociodemographic characteristics that are associated with both higher screening adherence and higher overall survival, such as higher income, higher education achievement , and higher access to health care.

Metastatic-free intervals and risk of breast cancer-specific mortality among patients with hormone receptor-positive breast cancer: A population-based analysis from the Surveillance, Epidemiology, and End Results registries.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e13034-e13034
Author(s):  
Gregory Sampang Calip ◽  
Ernest H Law ◽  
Colin Hubbard ◽  
Nadia Azmi Nabulsi ◽  
Alemseged Ayele Asfaw ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Diagnosis ◽  
Breast Cancer Diagnosis ◽  
Population Based ◽  
Breast Cancer Specific Survival ◽  
Cancer Specific Survival ◽  
Breast Cancer Specific Mortality ◽  
Specific Mortality ◽  
Cancer Specific Mortality ◽  
Positive Breast Cancer

e13034 Background: Patients successfully treated for hormone receptor (HR)-positive early breast cancer remain at risk of recurrence and metastatic disease even after extended periods of disease-free years. Whether prolonged metastatic-free intervals ultimately confer a benefit to breast cancer-specific survival is not well understood. This study aimed to investigate metastatic-free intervals and risk of breast cancer-specific mortality among patients with HR-positive breast cancer after adjuvant therapy. Methods: We conducted a retrospective cohort study of women aged 18 years and older diagnosed with recurrent metastatic HR-positive breast cancer between 1990 and 2016 in the Surveillance, Epidemiology, and End Results registries. Patients with longitudinal information on primary stage I-III HR-positive breast cancer through the occurrence of metastatic disease and survival were included. Risks of breast cancer-specific mortality associated with metastatic-free intervals (defined as time from primary breast cancer diagnosis to metastasis) of ≥5 years compared to < 5 years were estimated. Fine and Gray competing risks regression models were used to calculate subdistribution hazard ratios (SHR) and 95% confidence intervals (CI). Results: Among 1,057 women with HR-positive breast cancer with a median age of 54 years at primary breast cancer diagnosis and 62 years at metastatic progression, 65% of women had a metastatic-free disease interval ≥5 years, whereas 35% had an interval of < 5 years. Overall, patients with metastatic-free intervals < 5 years had a five-year breast cancer-specific survival rate of 31% compared to 52% in women with intervals of ≥5 years. In multivariable analyses adjusted for age, race, diagnosis year, grade, treatment and sites of metastasis, patients with intervals of ≥5 years had decreased risk of breast cancer-specific mortality (SHR = 0.72, 95% CI 0.58-0.89, P = 0.002) compared to women with metastatic-free intervals of < 5 years. Conclusions: In this population-based study, rates of cancer-specific mortality among patients who experienced metastatic recurrence of HR-positive breast cancer were lower in women with metastatic-free intervals of 5 years or more. The results of this study may inform patient-clinician discussions surrounding prognosis and treatment selection among HR-positive patients.

scholarly journals Use of Non-Cancer Medications in New Zealand Women at the Diagnosis of Primary Invasive Breast Cancer: Prevalence, Associated Factors and Effects on Survival

2020 ◽  
Vol 17 (21) ◽  
pp. 7962
Author(s):  
Phyu Sin Aye ◽  
Oliver W. Scott ◽  
J. Mark Elwood ◽  
Diana Sarfati ◽  
Ross Lawrenson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
New Zealand ◽  
Cancer Diagnosis ◽  
Associated Factors ◽  
Medication Use ◽  
Breast Cancer Diagnosis ◽  
Breast Cancer Specific Mortality ◽  
Primary Invasive Breast Cancer ◽  
Specific Mortality ◽  
Cancer Specific Mortality

Background: Assessing the use of multiple medications in cancer patients is crucial as such use may affect cancer outcomes. This study reports the prevalence of non-cancer medication use at breast cancer diagnosis, its associated factors, and its effect on survival. Methods: We identified all women diagnosed with primary invasive breast cancer between 1 January 2007 and 31 December 2016, from four population-based breast cancer registries, in Auckland, Waikato, Wellington, and Christchurch, New Zealand. Through linkage to the pharmaceutical records, we obtained information on non-cancer medications that were dispensed for a minimum of 90 days’ supply between one year before cancer diagnosis and first cancer treatment. We performed ordered logistic regressions to identify associated factors and Cox regressions to investigate its effect on patient survival. Results: Of 14,485 patients, 52% were dispensed at least one drug (mean—1.3 drugs; maximum—13 drugs), with a higher prevalence observed in patients who were older, treated at a public facility, more economically deprived, and screen-detected. The use of 2–3 drugs showed a reduced non-breast cancer mortality (HR = 0.75, 95%CI = 0.60–0.92) in previously hospitalised patients, with other groups showing non-significant associations when adjusted for confounding factors. Drug use was not associated with changes in breast cancer-specific mortality. Conclusions: Non-cancer medication use at breast cancer diagnosis was common in New Zealand, more prevalent in older and disadvantaged women, and showed no effect on breast cancer-specific mortality, but a reduction in other cause mortality with the use of 2–3 drugs.

scholarly journals Correction to: Factors associated with late risks of breast cancer‑specific mortality in the SEER registry

2021 ◽  
Author(s):  
José P. Leone ◽  
Carlos T. Vallejo ◽  
Michael J. Hassett ◽  
Julieta Leone ◽  
Noah Graham ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Third Party ◽  
Copyright Holder ◽  
Factors Associated ◽  
Internet Portal ◽  
Creative Commons ◽  
Credit Line ◽  
Breast Cancer Specific Mortality ◽  
Specific Mortality ◽  
Cancer Specific Mortality

The article “Factors associated with late risks of breast cancer‑specific mortality in the SEER registry”, written by José P. Leone, Carlos T. Vallejo, Michael J. Hassett, Julieta Leone, Noah Graham, Nabihah Tayob, Rachel A. Freedman, Sara M. Tolaney, Bernardo A. Leone, Eric P. Winer and Nancy U. Lin, was originally published electronically on the publisher’s internet portal on April 24, 2021 without open access. With the author(s)’ decision to opt for Open Choice the copyright of the article changed on May 11, 2021 to © The Author(s) 2021 and the article is forthwith distributed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0.

scholarly journals Impact of Preexisting Mental Illness on All-Cause and Breast Cancer–Specific Mortality in Elderly Patients With Breast Cancer

2017 ◽  
Vol 35 (36) ◽  
pp. 4012-4018 ◽  
Author(s):  
Kristy Iglay ◽  
Melissa L. Santorelli ◽  
Kim M. Hirshfield ◽  
Jill M. Williams ◽  
George G. Rhoads ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Mental Illness ◽  
Elderly Patients ◽  
Severe Mental Illness ◽  
Cancer Diagnosis ◽  
Breast Cancer Diagnosis ◽  
Breast Cancer Specific Mortality ◽  
Mortality Hazard ◽  
Specific Mortality ◽  
Cancer Specific Mortality

Purpose Limited data are available on the survival of patients with breast cancer with preexisting mental illness, and elderly women are of special interest because they experience the highest incidence of breast cancer. Therefore, we compared all-cause and breast cancer–specific mortality for elderly patients with breast cancer with and without mental illness. Methods A retrospective cohort study was conducted by using SEER-Medicare data, including 19,028 women ≥ 68 years of age who were diagnosed with stage I to IIIa breast cancer in the United States from 2005 to 2007. Patients were classified as having severe mental illness if an International Classification of Diseases, Ninth Edition, Clinical Modification code for bipolar disorder, schizophrenia, or other psychotic disorder was recorded on at least one inpatient or two outpatient claims during the 3 years before breast cancer diagnosis. Patients were followed for up to 5 years after breast cancer diagnosis to assess survival outcomes, which were then compared with those of patients without mental illness. Results Nearly 3% of patients had preexisting severe mental illness. We observed a two-fold increase in the all-cause mortality hazard between patients with severe mental illness compared with those without mental illness after adjusting for age, income, race, ethnicity, geographic location, and marital status (adjusted hazard ratio, 2.19; 95% CI, 1.84 to 2.60). A 20% increase in breast cancer–specific mortality hazard was observed, but the association was not significant (adjusted hazard ratio, 1.20; 95% CI, 0.82 to 1.74). Patients with severe mental illness were more likely to be diagnosed with advanced breast cancer and aggressive tumor characteristics. They also had increased tobacco use and more comorbidities. Conclusion Patients with severe mental illness may need assistance with coordinating medical services.

Breast cancer specific mortality in patients with early-stage hormone receptor–positive invasive breast cancer and oncotype DX recurrence score results in the SEER database.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 176-176 ◽  
Author(s):  
Steven Shak ◽  
Valentina Petkov ◽  
Dave P Miller ◽  
Nadia Howlader ◽  
Nathan Gliner ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Invasive Breast Cancer ◽  
Hormone Receptor ◽  
Early Stage ◽  
Recurrence Score ◽  
Oncotype Dx ◽  
Large Sample Size ◽  
Breast Cancer Specific Mortality ◽  
Specific Mortality ◽  
Cancer Specific Mortality

176 Background: NCI’s SEER Program provides cancer incidence and survival statistics for ~28% of the US. New research models are needed to characterize the use and impact of genomic tests on patient outcomes. Genomic Health and SEER collaborated to electronically supplement SEER registries with Recurrence Score (RS) results, and have evaluated breast cancer specific mortality (BCSM) in early stage hormone receptor (HR)+ HER2- invasive breast cancer. Methods: Pts were eligible for pre-specified node negative (N-) disease analysis if HR+, HER2- (by RT-PCR), no prior malignancy, 40-85 years of age, and diagnosed between Jan 2004 (Oncotype DX available Jan 2004) and Dec 2011 (SEER survival analysis complete through 2012). BCSM was defined as previously described (Howlader et al, JNCI 2010). Additional analyses of BCSM were performed for pts with N+ disease. Results: Of 169,158 eligible N- pts, 38,568 (23%) had a RS, increasing from 2% in 2004 to 35% in 2011. Pts with RS had median age of 57yr, were 99.4% female, 84% white, 29% grade 1 & 54% grade 2, 25% < 1cm & 53% 1-2cm. Median FU was 39mo. 8,239 pts had > 5yrs follow-up. Among RS < 18 (N = 21,023), RS 18-30 (N = 14,494) and RS ≥ 31 (N = 3,051) pts, chemotherapy use was reported in 7%, 34%, & 69%, respectively, and 5yr N- BCSM was 0.4% (95% CI, 0.3-0.6), 1.4% (95% CI, 1.1-1.7) and 4.4% (95% CI,3.4-5.6), respectively. Multivariate showed that RS was significantly associated with BCSM after adjusting for age, grade, and tumor size (p < 0.001), and when stratified by treatment (p < 0.001). BCSM results in additional N- subgroups (e.g., socioeconomic), and in > 60,000 N+ pts will be presented. Conclusions: 5yr survival outcomes are excellent in the over 21,000 N- pts with RS < 18 disease. RS ≥ 31 disease is associated with greater 5yr mortality despite addition of chemotherapy. The large sample size of this population-based observational study provides important information on prospective outcomes in subsets of pts that are often underrepresented in randomized clinical trials.

scholarly journals Factors associated with late risks of breast cancer-specific mortality in the SEER registry

2021 ◽  
Author(s):  
José P. Leone ◽  
Carlos T. Vallejo ◽  
Michael J. Hassett ◽  
Julieta Leone ◽  
Noah Graham ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Factors Associated ◽  
Breast Cancer Specific Mortality ◽  
Specific Mortality ◽  
Cancer Specific Mortality

Trends in the use of breast-conserving surgery and adjuvant radiation therapy in patients with DCIS: A U.S. population-based analysis from 1996 to 2007.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1110-1110
Author(s):  
Jennifer Nishimura ◽  
Audrey Choi ◽  
Sharon Kim ◽  
Julian Kim
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Breast Conserving Surgery ◽  
Adjuvant Radiation ◽  
Adjuvant Radiation Therapy ◽  
Factors Associated ◽  
Breast Cancer Specific Mortality ◽  
Time Period ◽  
Specific Mortality ◽  
Cancer Specific Mortality

1031 Background: The treatment for patients with DCIS remains controversial. Current guidelines based upon best available evidence suggest that breast conserving surgery (BCS) followed by adjuvant radiation therapy (RT) result in acceptable local control and breast cancer specific survival. The purpose of this study was to analyze trends in patterns of care as well as identify factors associated with surgery type and use of adjuvant radiation therapy in a select cohort of patients enrolled into the SEER database. Methods: The study included females 18 years and older with focal DCIS and known tumor size of 5 cm or less diagnosed between 1996 and 2007. The Cochran-Armitage trend test was applied to identify trends in the use of BCS and RT over time. Multivariate logistic regression analyses were used to determine factors associated with receiving BCS vs. mastectomy and BCS plus RT vs. BCS alone. Cox proportional hazard model was used to determine associations with breast cancer-specific mortality. Results: Of the 34,233 women with DCIS, 76.59% were treated with BCS. 66.36% of BCS patients received adjuvant RT over the study period. The proportion of women receiving BCS increased from 71.5% in 1996 to 76.9% in 2007 (p<0.0001). Additionally, the proportion of women who underwent BCS and received adjuvant radiation therapy over the same time period increased from 55.3% to 69.7% (p<0.0001). Multivariate analysis demonstrated that year of diagnosis, race, marital status, geographic region, tumor size, tumor grade and comedo necrosis all were significantly associated with the use of adjuvant radiation therapy, but age was not. Cox proportional hazards models did not associate either surgery type or use of adjuvant radiation in patients undergoing BCS with breast cancer-specific mortality. Conclusions: Based upon reporting within the SEER database, the proportion of DCIS patients undergoing BCS and the BCS patients receiving adjuvant radiation increased over the study time period. Surgery type and use of adjuvant radiation therapy in patients with BCS was not associated with decreased risk of breast-cancer specific death in this cohort.

scholarly journals Mammography screening and mortality by risk status in the California teachers study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hannah Lui Park ◽  
Jenny Chang ◽  
Vikram Haridass ◽  
Sophia S. Wang ◽  
Argyrios Ziogas ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Mammography Screening ◽  
Risk Category ◽  
Age Group ◽  
Breast Cancer Specific Mortality ◽  
Specific Mortality ◽  
Cancer Specific Mortality ◽  
Overall Mortality

Abstract Background The debate continues among medical professionals regarding the frequency, starting age, and stopping age for mammography screening. Some experts suggest tailoring recommendations based on individuals’ personal breast cancer risk. Previous studies have not compared the impact of annual versus biennial mammography stratified by age group and risk category. The purpose of this study was to examine the relationship between mammography frequency and mortality by age group and risk category in the California Teachers Study. Methods Using data from study questionnaires from 93,438 women between the ages of 40 and 85 and linkages to the California Cancer Registry and other indices, overall and breast cancer-specific mortality by mammography frequency were estimated using multivariable Cox proportional hazards models, stratified by age group and risk category at baseline as determined by the Gail breast cancer risk model. Results During the follow-up period of 20 years, overall mortality risk was lower in women who had annual or biennial mammography compared to less frequent or no mammography in all age groups. Annual mammography was associated with lower overall mortality risk compared to biennial mammography among women age 50–85. This difference was especially apparent in women age 60–74, regardless of estimated Gail risk category at baseline. Breast cancer-specific mortality was lower among women who had annual mammography compared to biennial or less frequent mammography among women age 60–74, regardless of their baseline risk. Conclusions Our findings suggest that at least biennial mammography is beneficial to most women age 40–85 and that annual mammography is more beneficial than biennial mammography to most women age 50–85 in terms of overall mortality.

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