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Breast Cancer Research and Treatment
Published in: Breast Cancer Research and Treatment 3/2011

01-02-2011 | Epidemiology

Outcomes following local therapy for early-stage breast cancer in non-trial populations

Authors: Nancy L. Keating, Mary Beth Landrum, John M. Brooks, Elizabeth A. Chrischilles, Eric P. Winer, Kara Wright, Rita Volya

Published in: Breast Cancer Research and Treatment | Issue 3/2011

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Abstract

Recent studies suggest trends toward more mastectomies for primary breast cancer treatment. We assessed survival after mastectomy and breast-conserving surgery (BCS) with radiation for early-stage breast cancer among non-selected populations of women and among women similar to those in clinical trials. Using population-based data from Surveillance Epidemiology, and End Results cancer registries linked with Medicare administrative data from 1992 to 2005, we conducted propensity score analysis of survival following primary therapy for early-stage breast cancer, including BCS with radiation, BCS without radiation, mastectomy with radiation, and mastectomy without radiation. Adjusted survival was greatest among women who had BCS with radiation (median survival = 10.98 years). Compared with this group, mortality was higher among women who had mastectomy without radiation (median survival 10.04 years, adjusted hazard ratio (HR) = 1.19, 95% confidence interval (CI) = 1.14–1.23), mastectomy with radiation (median survival 10.02 years, HR = 1.20, 95% CI = 1.14–1.27), and BCS without radiation (median survival 7.63 years, HR = 1.81, 95% CI = 1.70–1.92). Among women representative of those eligible for clinical trials (age ≤70 years, Charlson comorbidity score = 0/1, and stage 1 tumors), there were no differences in survival for women who underwent BCS with radiation or mastectomy. In conclusion, after careful adjustment for differences in patient, physician, and hospital characteristics, we found better survival for BCS with radiation versus mastectomy among older early-stage breast cancer patients, with no difference in survival for BCS with radiation versus mastectomy among women representative of those in clinical trials. These findings are reassuring in light of recent trends towards more aggressive primary breast cancer therapy.
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Literature
1.
Veronesi U, Saccozzi R, Del Vecchio M, Banfi A, Clemente C, De Lena M et al (1981) Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast. N Engl J Med 305(1):6–11CrossRefPubMed
2.
Sarrazin D, Le M, Rouesse J, Contesso G, Petit JY, Lacour J et al (1984) Conservative treatment versus mastectomy in breast cancer tumors with macroscopic diameter of 20 millimeters or less. The experience of the Institut Gustave-Roussy. Cancer 53(5):1209–1213CrossRefPubMed
3.
Fisher B, Bauer M, Margolese R, Poisson R, Pilch Y, Redmond C et al (1985) Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med 312(11):665–673CrossRefPubMed
4.
Fisher B, Redmond C, Poisson R, Margolese R, Wolmark N, Wickerham L et al (1989) Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer [published erratum appears in N Engl J Med 1994 May 19;330(20):1467]. N Engl J Med 320(13):822–828CrossRefPubMed
5.
Fisher B, Anderson S, Redmond CK, Wolmark N, Wickerham DL, Cronin WM (1995) Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 333(22):1456–1461CrossRefPubMed
6.
Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER et al (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347(16):1233–1241CrossRefPubMed
7.
Veronesi U, Banfi A, Salvadori B, Luini A, Saccozzi R, Zucali R et al (1990) Breast conservation is the treatment of choice in small breast cancer: long-term results of a randomized trial. Eur J Cancer 26(6):668–670CrossRefPubMed
8.
Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A et al (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347(16):1227–1232CrossRefPubMed
9.
Blichert-Toft M, Rose C, Andersen JA, Overgaard M, Axelsson CK, Andersen KW et al (1992) Danish randomized trial comparing breast conservation therapy with mastectomy: six years of life-table analysis. Danish Breast Cancer Cooperative Group. J Natl Cancer Inst Monogr (11):19–25
10.
Straus K, Lichter A, Lippman M, Danforth D, Swain S, Cowan K, et al (1992) Results of the National Cancer Institute early breast cancer trial. J Natl Cancer Inst Monogr (11):27–32
11.
Jacobson JA, Danforth DN, Cowan KH, d’Angelo T, Steinberg SM, Pierce L et al (1995) Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med 332(14):907–911CrossRefPubMed
12.
van Dongen JA, Voogd AC, Fentiman IS, Legrand C, Sylvester RJ, Tong D et al (2000) Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst 92(14):1143–1150CrossRefPubMed
13.
Early Breast Cancer Trialists’ Collaborative Group (1995) Effects of radiotherapy and surgery in early breast cancer. An overview of the randomized trials. N Engl J Med 333(22):1444–1455CrossRef
14.
National Institutes of Health Consensus Development Conference Statement (1990) Treatment of early stage breast cancer. In: National Institutes of Health (ed) 1990 June 18–21. National Institutes of Health, Bethesda, MD
15.
16.
Guadagnoli E, Weeks JC, Shapiro CL, Gurwitz JH, Borbas C, Soumerai SB (1998) Use of breast-conserving surgery for treatment of stage I and stage II breast cancer. J Clin Oncol 16(1):101–106PubMed
17.
Molenaar S, Oort F, Sprangers M, Rutgers E, Luiten E, Mulder J et al (2004) Predictors of patients’ choices for breast-conserving therapy or mastectomy: a prospective study. Br J Cancer 90(11):2123–2130PubMed
18.
Nold RJ, Beamer RL, Helmer SD, McBoyle MF (2000) Factors influencing a woman’s choice to undergo breast-conserving surgery versus modified radical mastectomy. Am J Surg 180(6):413–418CrossRefPubMed
19.
Temple WJ, Russell ML, Parsons LL, Huber SM, Jones CA, Bankes J et al (2006) Conservation surgery for breast cancer as the preferred choice: a prospective analysis. J Clin Oncol 24(21):3367–3373CrossRefPubMed
20.
Katipamula R, Degnim AC, Hoskin T, Boughey JC, Loprinzi C, Grant CS et al (2009) Trends in mastectomy rates at the Mayo Clinic Rochester: effect of surgical year and preoperative magnetic resonance imaging. J Clin Oncol 27(25):4082–4088CrossRefPubMed
21.
Tuttle TM, Habermann EB, Grund EH, Morris TJ, Virnig BA (2007) Increasing use of contralateral prophylactic mastectomy for breast cancer patients: a trend toward more aggressive surgical treatment. J Clin Oncol 25(33):5203–5209CrossRefPubMed
22.
McLaughlin CC, Lillquist PP, Edge SB (2009) Surveillance of prophylactic mastectomy: trends in use from 1995 through 2005. Cancer 115(23):5404–5412CrossRefPubMed
23.
Tuttle TM, Jarosek S, Habermann EB, Arrington A, Abraham A, Morris TJ et al (2009) Increasing rates of contralateral prophylactic mastectomy among patients with ductal carcinoma in situ. J Clin Oncol 27(9):1362–1367CrossRefPubMed
24.
Tejeda HA, Green SB, Trimble EL, Ford L, High JL, Ungerleider RS et al (1996) Representation of African-Americans, Hispanics, and whites in National Cancer Institute cancer treatment trials. J Natl Cancer Inst 88(12):812–816CrossRefPubMed
25.
Goodwin JS, Hunt WC, Humble CG, Key CR, Samet JM (1988) Cancer treatment protocols. Who gets chosen? Arch Intern Med 148(10):2258–2260CrossRefPubMed
26.
Hutchins LF, Unger JM, Crowley JJ, Coltman CA Jr, Albain KS (1999) Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med 341(27):2061–2067CrossRefPubMed
27.
Lewis JH, Kilgore ML, Goldman DP, Trimble EL, Kaplan R, Montello MJ et al (2003) Participation of patients 65 years of age or older in cancer clinical trials. J Clin Oncol 21(7):1383–1389CrossRefPubMed
28.
Murthy VH, Krumholz HM, Gross CP (2004) Participation in cancer clinical trials: race-, sex-, and age-based disparities. JAMA 291(22):2720–2726CrossRefPubMed
29.
Potosky AL, Riley GF, Lubitz JD, Mentnech RM, Kessler LG (1993) Potential for cancer related health services research using a linked Medicare-tumor registry database. Med Care 31(8):732–748CrossRefPubMed
30.
Warren JL, Klabunde CN, Schrag D, Bach PB, Riley GF (2002) Overview of the SEER-Medicare data—content, research applications, and generalizability to the United States elderly population. Med Care 40(8, Supplement):IV-3–IV-18
31.
32.
Keating NL, Landrum MB, Ayanian JZ, Winer EP, Guadagnoli E (2003) Consultation with a medical oncologist before surgery and type of surgery among elderly women with early-stage breast cancer. J Clin Oncol 21(24):4532–4539CrossRefPubMed
33.
Keating NL, Landrum MB, Meara EM, Ganz PA, Guadagnoli E (2005) Do increases in managed care market share influence quality of cancer care in the fee-for-service sector? J Natl Cancer Inst 97(4):257–264CrossRefPubMed
34.
Cooper GS, Virnig B, Klabunde CN, Schussler N, Freeman J, Warren JL (2002) Use of SEER-Medicare data for measuring cancer surgery. Med Care 40(8 Suppl): IV-43–IV-48
35.
Du X, Freeman JL, Goodwin JS (1999) Information on radiation treatment in patients with breast cancer: the advantages of the linked medicare and SEER data. Surveillance, Epidemiology and End Results. J Clin Epidemiol 52(5):463–470CrossRefPubMed
36.
Ellis RP, Pope GC, Iezzoni LI, Ayanian JZ, Bates DW, Burstin H et al (1996) Diagnosis-based risk adjustment for Medicare capitation payments. Health Care Financ Rev 17(3):101–128PubMed
37.
Baldwin LM, Klabunde CN, Green P, Barlow W, Wright G (2006) In search of the perfect comorbidity measure for use with administrative claims data: does it exist? Med Care 44(8):745–753CrossRefPubMed
38.
Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383CrossRefPubMed
39.
American Joint Committee on Cancer (1988) Manual for staging of cancer, 3rd edn. J.B. Lippincott Company, New York, NY
40.
Baldwin LM, Adamache W, Klabunde CN, Kenward K, Dahlman C, J LW (2002) Linking physician characteristics and medicare claims data: issues in data availability, quality, and measurement. Med Care 40(8 Suppl): IV-82–IV-95
41.
Schrag D, Bach PB, Dahlman C, Warren JL (2002) Identifying and measuring hospital characteristics using the SEER-Medicare data and other claims-based sources. Med Care 40(8 Suppl): IV-96–IV-103
42.
Begg CB, Cramer LD, Hoskins WJ, Brennan MF (1998) Impact of hospital volume on operative mortality for major cancer surgery. JAMA 280(20):1747–1751CrossRefPubMed
43.
Bach PB, Cramer LD, Schrag D, Downey RJ, Gelfand SE, Begg CB (2001) The influence of hospital volume on survival after resection for lung cancer. N Engl J Med 345(3):181–188CrossRefPubMed
44.
Bianco FJ Jr, Riedel ER, Begg CB, Kattan MW, Scardino PT (2005) Variations among high volume surgeons in the rate of complications after radical prostatectomy: further evidence that technique matters. The Journal of urology 173(6):2099–2103CrossRefPubMed
45.
Rubin DB (1979) Using multivariate matched sampling and regression adjustment to control bias in observational studies. J Am Soc Assoc 74:318–328CrossRef
46.
Rubin DB (1997) Estimating causal effects from large data sets using propensity scores. Ann Intern Med 127(8S):757–763PubMed
47.
Huang IC, Frangakis C, Dominici F, Diette GB, Wu AW (2005) Application of a propensity score approach for risk adjustment in profiling multiple physician groups on asthma care. Health Serv Res 40(1):253–278CrossRefPubMed
48.
Imbens GW (2000) The role of propensity score in estimating dose-response functions. Biometrika 87:706–710CrossRef
49.
Klabunde CN, Potosky AL, Legler JM, Warren JL (2000) Development of a comorbidity index using physician claims data. J Clin Epidemiol 53(12):1258–1267CrossRefPubMed
50.
Rosenbaum PR, Rubin DB (1983) Assessing sensitivity to an unobserved binary covariate in an observational study with binary outcomes. J R Stat Soc 45:212–218
51.
Lin DY, Psaty BM, Kronmal RA (1998) Assessing the sensitivity of regression results to unmeasured confounders in observational studies. Biometrics 54:948–963CrossRefPubMed
52.
Early Breast Cancer Trialists’ Collaborative Group (1998) Tamoxifen for early breast cancer: an overview of the randomised trials. Lancet 351(9114):1451–1467CrossRef
53.
Harlan LC, Clegg LX, Abrams J, Stevens JL, Ballard-Barbash R (2006) Community-based use of chemotherapy and hormonal therapy for early-stage breast cancer: 1987–2000. J Clin Oncol 24(6):872–877CrossRefPubMed
54.
Lamont EB, Hayreh D, Pickett KE, Dignam JJ, List M, Stenson K et al (2003) Is patient travel distance associated with survival on phase II clinical trials in oncology? J Natl Cancer Inst 95(18):1370–1375PubMed
55.
Jackson N, Fuchs C, Niedzwiecki D, Hollis D, Saltz L, Mayer R et al (2008) The impact of smoking on cancer recurrence and survival in patients with stage III colon cancer: findings from intergroup trial CALGB 89803. J Clin Oncol 26:(May 20 suppl; abstr 4039)
56.
Klevens RM, Giovino GA, Peddicord JP, Nelson DE, Mowery P, Grummer-Strawn L (1995) The association between veteran status and cigarette-smoking behaviors. Am J Prev Med 11(4):245–250PubMed
57.
Stavraky KM, Skillings JR, Stitt LW, Gwadry-Sridhar F (1996) The effect of socioeconomic status on the long-term outcome of cancer. J Clin Epidemiol 49(10):1155–1160CrossRefPubMed
58.
Konski A, Berkey BA, Kian Ang K, Fu KK (2003) Effect of education level on outcome of patients treated on Radiation Therapy Oncology Group Protocol 90-03. Cancer 98(7):1497–1503CrossRefPubMed
59.
Dawood S, Gonzalez-Angulo AM, Woodward W, Meric-Bernstam F, Hunt K, Buzdar A et al (2009) Value of adjuvant radiation therapy in breast cancer patients with one to three positive lymph nodes undergoing a modified radical mastectomy and systemic therapy. J Clin Oncol 27(15s):(suppl; abstr 507)
60.
Punglia RS, Morrow M, Winer EP, Harris JR (2007) Local therapy and survival in breast cancer. N Engl J Med 356(23):2399–2405CrossRefPubMed
61.
Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans E et al (2005) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 366(9503):2087–2106PubMed
62.
Smith BD, Haffty BG, Hurria A, Galusha DH, Gross CP (2006) Postmastectomy radiation and survival in older women with breast cancer. J Clin Oncol 24(30):4901–4907CrossRefPubMed
63.
Buchholz TA, Woodward WA, Duan Z, Fang S, Oh JL, Tereffe W et al (2008) Radiation use and long-term survival in breast cancer patients with T1, T2 primary tumors and one to three positive axillary lymph nodes. Int J Radiat Oncol Biol Phys 71(4):1022–1027CrossRefPubMed
64.
Trimble EL, Carter CL, Cain D, Freidlin B, Ungerleider RS, Friedman MA (1994) Representation of older patients in cancer treatment trials. Cancer 74(7 Suppl):2208–2214CrossRefPubMed
65.
Giordano SH, Kuo YF, Duan Z, Hortobagyi GN, Freeman J, Goodwin JS (2008) Limits of observational data in determining outcomes from cancer therapy. Cancer 112(11):2456–2466CrossRefPubMed
66.
Brooks JM, Chrischilles E, Scott S, Chen-Hardee S (2003) Was breast conserving surgery underutilized for early-stage breast cancer?—Instrumental variables evidence for stage II patients from Iowa. Health Serv Res 38(6):1385–1402CrossRefPubMed
67.
Hadley J, Polsky D, Mandelblatt JS, Mitchell JM, Weeks JC, Wang Q et al (2003) An exploratory instrumental variable analysis of the outcomes of localized breast cancer treatments in a Medicare population. Health Econ 12:171–186CrossRefPubMed
68.
James DS, Bull AD (1996) Information on death certificates: cause for concern? J Clin Pathol 49(3):213–216CrossRefPubMed
Metadata
Title
Outcomes following local therapy for early-stage breast cancer in non-trial populations
Authors
Nancy L. Keating
Mary Beth Landrum
John M. Brooks
Elizabeth A. Chrischilles
Eric P. Winer
Kara Wright
Rita Volya
Publication date
01-02-2011
Publisher
Springer US
Published in
Breast Cancer Research and Treatment / Issue 3/2011
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI
https://doi.org/10.1007/s10549-010-0865-4

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