Disparities in the Initial Local Treatment of Older Women with Early-Stage Breast Cancer: A Population-Based Study

LeMasters, Traci; Madhavan, Suresh; Sambamoorthi, Usha; Vyas, Ami

doi:10.1089/jwh.2015.5639

Cited by 16 publications

(13 citation statements)

References 36 publications

(40 reference statements)

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“…Despite ﬂexibility in treatment guidelines, treatment disparities reported by previous studies raise concern that older women are undertreated more frequently than warranted. Recent studies have reported that among women aged ≥65 years, 21% to 29% did not receive RT following BCS for early-stage breast cancer regardless of their ER status, 4,15 67% with lymph node–positive disease did not receive chemotherapy, 9 50% did not receive trastuzumab, 16 and 17% to 40% did not receive AET when indicated. 5 Moreover, age and comorbidity have been found to be the strongest predictors of treatment, irrespective of clinical indications.…”

Section: Introductionmentioning

confidence: 99%

Receipt of Guideline-Concordant Care Among Older Women With Stage I–III Breast Cancer: A Population-Based Study

LeMasters¹,

Madhavan²,

Sambamoorthi³

et al. 2018

J Natl Compr Canc Netw

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This study examined receipt of guideline-concordant care (GCC) according to evidence-based treatment guidelines and quality measures and specific types of treatment among older women with breast cancer. A total of 142,433 patients aged ≥66 years diagnosed with stage I-III breast cancer between 2007 and 2011 were identified in the SEER-Medicare linked database. Algorithms considering cancer characteristics and the appropriate course of care as per guidelines versus actual care received determined receipt of GCC. Multivariable logistic regression estimated the likelihood of GCC and specific types of treatment for women aged ≥75 versus 66 to 74 years. Overall, 39.7% of patients received GCC. Patients diagnosed at stage II or III, with certain preexisting conditions, and of nonwhite race were less likely to receive GCC. Patients with hormone-negative tumors, higher grade tumors, and greater access to oncology care resources were more likely to receive GCC. Patients aged ≥75 years were approximately 40% less likely to receive GCC or adjuvant endocrine therapy, 78% less likely to have any surgery, 61% less likely to have chemotherapy, and about half as likely to have radiation therapy than those aged 66 to 74 years. Fewer than half of older women with breast cancer received GCC, with the lowest rates observed among the oldest age groups, racial/ethnic minorities, and women with later-stage cancers. However, patients with more aggressive tumor characteristics and greater access to oncology resources were more likely to receive GCC. Considering that older women have the highest incidence of breast cancer and that many are diagnosed at stages requiring more aggressive treatment, efforts to increase rates of earlier stage diagnosis and the development of less toxic treatments could help improve GCC and survival while preserving quality of life.

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Section: Introductionmentioning

confidence: 99%

Receipt of Guideline-Concordant Care Among Older Women With Stage I–III Breast Cancer: A Population-Based Study

LeMasters¹,

Madhavan²,

Sambamoorthi³

et al. 2018

J Natl Compr Canc Netw

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“…Comprehensive analyses of local-regional treatment patterns (mastectomy vs. lumpectomy alone vs. lumpectomy+radiation) in elderly women with early-stage breast cancer are few. Lemasters et al has performed the most detailed analysis using SEER-Medicare data from 2003 to 2009 (16). Comparisons with our study are limited as Lemasters et al included women with higher stage breast cancer (stage II), ER- disease, and younger women aged 66–69 years old.…”

Section: Discussionmentioning

confidence: 99%

Assessing the Impact of CALGB 9343 on Surgical Trends in Elderly-Women With Stage I ER+ Breast Cancer: A SEER-Based Analysis

et al. 2019

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Purpose: Lumpectomy (L) and breast radiotherapy (RT) results in equivalent outcomes in comparison to mastectomy (M) for early-stage breast cancer (BC) based on randomized controlled trials (RCT). Since 2004, RCT support that L without RT yields equivalent survival and acceptable local-regional outcomes in women ≥70-years old with T1N0 hormone-sensitive (ER+) BC on endocrine therapy. Based on this, we hypothesized that M rates should decrease substantially after 2004 in this low-risk elderly population. Methods: We used the Surveillance Epidemiology and End Results registry data to conduct this study. We included women with T1N0 ER+ BC from 2000 to 2014. We compared M rates in women diagnosed from 2000 to 2004 vs. 2005–2012 using the Chi-Square test. Logistic regression analyses was performed to examine demographic/clinical factors associated with mastectomy. Results: 67,506 women met the study criteria. In elderly Stage I ER+ BC, the M rate decreased by 6.3%: 29.0% before 2004 to 22.7% after 2004 ( p < 0.0001). M rates remained higher in elderly non-Hispanic black (NHB, 27.1%, p < 0.0001), non-Hispanic Asian-Pacific-Islander (NHAPI, 30.1%, p < 0.0001), and Hispanics (24.4%, p = 0.0004) vs. non-Hispanic White (NHW, 21.5%). Treatment in the modern cohort was associated with decreased odds of mastectomy (OR = 0.71, 95% CI 0.68-0.74, p < 0.0001) while NH-API race was associated with the highest increased odds of mastectomy (OR = 1.65, 95% 1.53-1.78, p < 0.0001). In the modern cohort specifically (2005–2014), Hispanic women (OR = 1.12, p = 0.014), NHB women (OR = 1.21, p < 0.0001), and NHAPI women (OR = 1.73, p < 0.0001) all had higher odds of undergoing mastectomy relative to NHW women after adjusting for all other patient and tumor related factors. Conclusions: In elderly patients with stage I, ER+ BC, M rates have decreased modestly since 2004. These trends are driven mostly be decreases in the M rate in NHW women, but M rates remain ~25% in Hispanic, NHB, and NHAPI women. Further research is needed to identify why M, which is associated with higher cost and morbidity than L alone, has not changed substantially in elderly, low-risk BC.

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“…In this study, we found that patients who received Japanese standard high tangent field radiotherapy after surgery had better DFS and OS than those in the nonirradiated group. Radiation therapy is sometimes omitted owing to older age or comorbidities . Since this study included patients with various characteristics and age ranges, propensity‐score–matched analysis was performed.…”

Section: Discussionmentioning

confidence: 99%

“…When the resection margin was close to the cancer lesion after breast‐conserving surgery, 10.0 Gy was added as a boost for all patients . For some of elderly patients aged over 70 years, hypofractionated radiation therapy (42.4 Gy in 16 fractions) with or without boost addition (10.6 Gy in 4 fractions) and radiation omission were options if she or he could receive endocrine therapy for luminal A‐like, stage I disease …”

Section: Introductionmentioning

confidence: 99%

Prevention of locoregional recurrence and distant metastasis in Japanese breast cancer patients using Japanese standard postoperative radiation fields: Experience at a single institution

et al. 2019

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Background: Radiotherapy is an effective local control therapy for breast cancer.Locoregional control is associated with distant metastasis risk and survival after surgery. Aim:We aimed to evaluate whether Japanese standard postoperative radiotherapy after surgery correlates with disease-free survival (DFS) and overall survival and clarify the characteristics of patients who benefit from it. Method and Results:This retrospective study included 626 operable breast cancer patients. Tumor characteristics and survival outcomes were compared between patients who received radiotherapy and those who did not. Cox proportional hazard analysis was used to analyze prognostic factors for DFS and perform subgroup analysis. Propensity score matching was used to evaluate the efficacy of radiotherapy using a logistic regression model in patients who received radiotherapy or did not.The median follow-up duration after diagnosis of breast cancer was 63 months.DFS and overall survival were better in the irradiated group (P= .002 and P = .001, respectively). Radiotherapy was more effective for estrogen receptor (ER)-positive disease and for early breast cancer without lymph node metastasis. Multivariate analysis revealed that radiotherapy was a dependent risk factor for recurrence or metastasis.Conclusion: Radiotherapy prevents distant metastasis and recurrence in early breast cancer patients. In particular, ER-positive, node-negative patients benefit from Japanese standard tangent field radiation.

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Disparities in the Initial Local Treatment of Older Women with Early-Stage Breast Cancer: A Population-Based Study

Abstract: Over half of older women with ESBC initially receive BCS+RT. The likelihood for mastectomy and BCS only increases with age, comorbidity, and vulnerable socio-demographic characteristics. Findings demonstrate continued treatment disparities among certain vulnerable populations.

Cited by 16 publications

References 36 publications

Receipt of Guideline-Concordant Care Among Older Women With Stage I–III Breast Cancer: A Population-Based Study

Receipt of Guideline-Concordant Care Among Older Women With Stage I–III Breast Cancer: A Population-Based Study

Assessing the Impact of CALGB 9343 on Surgical Trends in Elderly-Women With Stage I ER+ Breast Cancer: A SEER-Based Analysis

Prevention of locoregional recurrence and distant metastasis in Japanese breast cancer patients using Japanese standard postoperative radiation fields: Experience at a single institution

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