Mortality Impact of Less-than-Standard Therapy in Older Breast Cancer Patients
Background The purpose of this study was to compare the rates of all-cause and breast cancer–specific mortality after breast-conserving surgery (BCS) only, BCS plus radiation therapy (RT), mastectomy, and the receipt of adjuvant tamoxifen in a large population-based cohort of older women with early-...
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Published in | Journal of the American College of Surgeons Vol. 206; no. 1; pp. 66 - 75 |
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Main Authors | , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
New York, NY
Elsevier Inc
2008
Elsevier Science |
Subjects | |
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Abstract | Background The purpose of this study was to compare the rates of all-cause and breast cancer–specific mortality after breast-conserving surgery (BCS) only, BCS plus radiation therapy (RT), mastectomy, and the receipt of adjuvant tamoxifen in a large population-based cohort of older women with early-stage disease. Study Design This cohort study was conducted within six US integrated health-care delivery systems. Automated administrative databases, medical records, and tumor registries were used to identify women aged 65 years or older who received BCS or mastectomy to treat stage I or II breast cancer diagnosed from January 1, 1990, through December 31, 1994. We compared cause-specific 10-year mortality rates across treatment categories by fitting Cox proportional hazards models adjusted for demographics and tumor characteristics. Results We identified 1,837 women having operations for stage I or II breast cancer. Compared with women receiving mastectomy, those receiving BCS without RT were twice as likely to die of breast cancer (adjusted hazards ratio [HR] = 2.19, 95% confidence interval [CI], 1.51 to 3.18). Breast cancer mortality rates were similar between women receiving BCS plus RT and women receiving mastectomy (adjusted HR = 1.08, 95% CI, 0.79 to 1.48). In the subset of 886 chemotherapy-naive women treated with tamoxifen, those treated with tamoxifen for less than 1 year had a substantially higher breast cancer mortality rate than those exposed 5 years or more (adjusted HR = 6.26, 95% CI, 3.10 to 12.64). Conclusions Our findings indicate that older women receiving BCS alone have higher rates of breast cancer death than those receiving BCS + RT or mastectomy and that the survival benefit from tamoxifen increases with increasing duration of treatment. |
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AbstractList | BACKGROUNDThe purpose of this study was to compare the rates of all-cause and breast cancer-specific mortality after breast-conserving surgery (BCS) only, BCS plus radiation therapy (RT), mastectomy, and the receipt of adjuvant tamoxifen in a large population-based cohort of older women with early-stage disease.STUDY DESIGNThis cohort study was conducted within six US integrated health-care delivery systems. Automated administrative databases, medical records, and tumor registries were used to identify women aged 65 years or older who received BCS or mastectomy to treat stage I or II breast cancer diagnosed from January 1, 1990, through December 31, 1994. We compared cause-specific 10-year mortality rates across treatment categories by fitting Cox proportional hazards models adjusted for demographics and tumor characteristics.RESULTSWe identified 1,837 women having operations for stage I or II breast cancer. Compared with women receiving mastectomy, those receiving BCS without RT were twice as likely to die of breast cancer (adjusted hazards ratio [HR]=2.19, 95% confidence interval [CI], 1.51 to 3.18). Breast cancer mortality rates were similar between women receiving BCS plus RT and women receiving mastectomy (adjusted HR=1.08, 95% CI, 0.79 to 1.48). In the subset of 886 chemotherapy-naive women treated with tamoxifen, those treated with tamoxifen for less than 1 year had a substantially higher breast cancer mortality rate than those exposed 5 years or more (adjusted HR=6.26, 95% CI, 3.10 to 12.64).CONCLUSIONSOur findings indicate that older women receiving BCS alone have higher rates of breast cancer death than those receiving BCS + RT or mastectomy and that the survival benefit from tamoxifen increases with increasing duration of treatment. The purpose of this study was to compare the rates of all-cause and breast cancer-specific mortality after breast-conserving surgery (BCS) only, BCS plus radiation therapy (RT), mastectomy, and the receipt of adjuvant tamoxifen in a large population-based cohort of older women with early-stage disease. This cohort study was conducted within six US integrated health-care delivery systems. Automated administrative databases, medical records, and tumor registries were used to identify women aged 65 years or older who received BCS or mastectomy to treat stage I or II breast cancer diagnosed from January 1, 1990, through December 31, 1994. We compared cause-specific 10-year mortality rates across treatment categories by fitting Cox proportional hazards models adjusted for demographics and tumor characteristics. We identified 1,837 women having operations for stage I or II breast cancer. Compared with women receiving mastectomy, those receiving BCS without RT were twice as likely to die of breast cancer (adjusted hazards ratio [HR]=2.19, 95% confidence interval [CI], 1.51 to 3.18). Breast cancer mortality rates were similar between women receiving BCS plus RT and women receiving mastectomy (adjusted HR=1.08, 95% CI, 0.79 to 1.48). In the subset of 886 chemotherapy-naive women treated with tamoxifen, those treated with tamoxifen for less than 1 year had a substantially higher breast cancer mortality rate than those exposed 5 years or more (adjusted HR=6.26, 95% CI, 3.10 to 12.64). Our findings indicate that older women receiving BCS alone have higher rates of breast cancer death than those receiving BCS + RT or mastectomy and that the survival benefit from tamoxifen increases with increasing duration of treatment. Background The purpose of this study was to compare the rates of all-cause and breast cancer–specific mortality after breast-conserving surgery (BCS) only, BCS plus radiation therapy (RT), mastectomy, and the receipt of adjuvant tamoxifen in a large population-based cohort of older women with early-stage disease. Study Design This cohort study was conducted within six US integrated health-care delivery systems. Automated administrative databases, medical records, and tumor registries were used to identify women aged 65 years or older who received BCS or mastectomy to treat stage I or II breast cancer diagnosed from January 1, 1990, through December 31, 1994. We compared cause-specific 10-year mortality rates across treatment categories by fitting Cox proportional hazards models adjusted for demographics and tumor characteristics. Results We identified 1,837 women having operations for stage I or II breast cancer. Compared with women receiving mastectomy, those receiving BCS without RT were twice as likely to die of breast cancer (adjusted hazards ratio [HR] = 2.19, 95% confidence interval [CI], 1.51 to 3.18). Breast cancer mortality rates were similar between women receiving BCS plus RT and women receiving mastectomy (adjusted HR = 1.08, 95% CI, 0.79 to 1.48). In the subset of 886 chemotherapy-naive women treated with tamoxifen, those treated with tamoxifen for less than 1 year had a substantially higher breast cancer mortality rate than those exposed 5 years or more (adjusted HR = 6.26, 95% CI, 3.10 to 12.64). Conclusions Our findings indicate that older women receiving BCS alone have higher rates of breast cancer death than those receiving BCS + RT or mastectomy and that the survival benefit from tamoxifen increases with increasing duration of treatment. The purpose of this study was to compare the rates of all-cause and breast cancer–specific mortality after breast-conserving surgery (BCS) only, BCS plus radiation therapy (RT), mastectomy, and the receipt of adjuvant tamoxifen in a large population-based cohort of older women with early-stage disease. This cohort study was conducted within six US integrated health-care delivery systems. Automated administrative databases, medical records, and tumor registries were used to identify women aged 65 years or older who received BCS or mastectomy to treat stage I or II breast cancer diagnosed from January 1, 1990, through December 31, 1994. We compared cause-specific 10-year mortality rates across treatment categories by fitting Cox proportional hazards models adjusted for demographics and tumor characteristics. We identified 1,837 women having operations for stage I or II breast cancer. Compared with women receiving mastectomy, those receiving BCS without RT were twice as likely to die of breast cancer (adjusted hazards ratio [HR] = 2.19, 95% confidence interval [CI], 1.51 to 3.18). Breast cancer mortality rates were similar between women receiving BCS plus RT and women receiving mastectomy (adjusted HR = 1.08, 95% CI, 0.79 to 1.48). In the subset of 886 chemotherapy-naive women treated with tamoxifen, those treated with tamoxifen for less than 1 year had a substantially higher breast cancer mortality rate than those exposed 5 years or more (adjusted HR = 6.26, 95% CI, 3.10 to 12.64). Our findings indicate that older women receiving BCS alone have higher rates of breast cancer death than those receiving BCS + RT or mastectomy and that the survival benefit from tamoxifen increases with increasing duration of treatment. |
Author | Prout, Marianne N., MD, MPH Quinn, Virginia P., PhD, MPH Silliman, Rebecca A., MD, PhD Owusu, Cynthia, MD, MSc Thwin, Soe Soe, PhD, MS Frost, Floyd J., PhD Wei, Feifei, PhD Lash, Timothy L., DSc, MPH Buist, Diana S.M., PhD, MPH Ulcickas Yood, Marianne, DSc, MPH Geiger, Ann M., PhD, MPH Field, Terry S., DSc |
Author_xml | – sequence: 1 fullname: Ulcickas Yood, Marianne, DSc, MPH – sequence: 2 fullname: Owusu, Cynthia, MD, MSc – sequence: 3 fullname: Buist, Diana S.M., PhD, MPH – sequence: 4 fullname: Geiger, Ann M., PhD, MPH – sequence: 5 fullname: Field, Terry S., DSc – sequence: 6 fullname: Thwin, Soe Soe, PhD, MS – sequence: 7 fullname: Lash, Timothy L., DSc, MPH – sequence: 8 fullname: Prout, Marianne N., MD, MPH – sequence: 9 fullname: Wei, Feifei, PhD – sequence: 10 fullname: Quinn, Virginia P., PhD, MPH – sequence: 11 fullname: Frost, Floyd J., PhD – sequence: 12 fullname: Silliman, Rebecca A., MD, PhD |
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Keywords | estrogen receptor positive PR RT BCS breast-conserving surgery AJCC radiation therapy HR hazards ratio progesterone receptor positive American Joint Commission on Cancer ER Human Therapy Mortality Patient Breast cancer Standard Malignant tumor Epidemiology Standards Medicine Mammary gland diseases Treatment Surgery Mammary gland Elderly Age Cancer |
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Snippet | Background The purpose of this study was to compare the rates of all-cause and breast cancer–specific mortality after breast-conserving surgery (BCS) only, BCS... The purpose of this study was to compare the rates of all-cause and breast cancer–specific mortality after breast-conserving surgery (BCS) only, BCS plus... The purpose of this study was to compare the rates of all-cause and breast cancer-specific mortality after breast-conserving surgery (BCS) only, BCS plus... BACKGROUNDThe purpose of this study was to compare the rates of all-cause and breast cancer-specific mortality after breast-conserving surgery (BCS) only, BCS... |
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SubjectTerms | Aged Aged, 80 and over Antineoplastic Agents, Hormonal - therapeutic use Biological and medical sciences Breast Neoplasms - mortality Breast Neoplasms - pathology Breast Neoplasms - therapy Epidemiology Female Follow-Up Studies General aspects Humans Mastectomy - methods Medical sciences Neoplasm Staging Proportional Hazards Models Public health. Hygiene Public health. Hygiene-occupational medicine Radiotherapy, Adjuvant - methods Retrospective Studies Surgery Survival Rate - trends Tamoxifen - therapeutic use Treatment Outcome United States - epidemiology |
Title | Mortality Impact of Less-than-Standard Therapy in Older Breast Cancer Patients |
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