Outcome analysis of breast cancer patients who declined evidence-based treatment

The general aim of this systematic review is to mitigate breast cancer (BC) overdiagnosis and overtreatment. The specific aim is to summarize available data on the occurrence and features of indolent invasive or in situ (DCIS) BC, and precisely survival of untreated cases, prevalence of occult cancers found in autopsies, frequency of regressive BC. PubMed, Embase and Cochrane Library were systematically searched up to 3/31/2014. Eligibility criteria were: cohort studies, case-control studies, uncontrolled case series assessing survival in women with a diagnosis of BC who did not receive treatment compared to treated women; case series of autopsies estimating the prevalence of undiagnosed BC; cohort studies, case-control studies, uncontrolled case series, case reports assessing the occurrence of spontaneous regression of BC in women with a confirmed histology diagnosis. Untreated BC: 8 cohort studies and 12 case series (3593 BC) were included. In three controlled cohort studies (diagnoses 1978-2006), the 5-years overall survival was 19-43%. Occult BC: 8 case series (2279 autopsies) were included. The prevalence of invasive BC undiagnosed during lifetime range was 0-1.5%, while for DCIS the range was 0.2-14.7%. Spontaneous regression: 2 cohort studies, 3 case reports, 1 case series included. In the cohort studies the relative risk of regression for screen detected compared with nonscreened BC was estimated as 1.2 and 1.1. It seems plausible that around 10% of invasive BC are not symptomatic during life, and that one fith of BC patients if untreated would be alive after 5 years. Around 1 of 10 screen-detected BC may regress according two studies.There is a long standing debate on breast cancer (BC) natural history.1,2 A model suited to the current understanding of cancer biology includes cases with rapid development or early dissemination, cases likely to progress slowly if untreated, and indolent or regressive lesions. 3BC screening has contributed to the understanding of the complexity of the natural history of the neoplastic process. It allowed to detect early preclinical stages and to improve the diagnostic process aiming at identifying and treating those conditions most likely associated with morbidity and mortality.

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“…Twenty studies (22 articles) were included . Four of these have been included using also data reported in the Johnstone review .…”

Section: Resultsmentioning

confidence: 99%

Epidemiologic evidence of slow growing, nonprogressive or regressive breast cancer: A systematic review

et al. 2016

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“…[6][7][8][9][10]13,14 However, what may be counterintuitive is that patients living closer to treatment facilities were more likely to refuse therapy. There were several associated factors, not limited to sociodemographic, economic, clinicopathologic, and facilityrelated factors.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8][9][10] Identifying the patients most likely to refuse recommended oncologic Arya Amini and Vivek Verma contributed equally to this work. Across multiple disease sites, the rate of patient refusal ranges from 1% to 4%.…”

Section: Introductionmentioning

confidence: 99%

Factors predicting for patient refusal of head and neck cancer therapy

Amini

Verma

et al. 2019

Head & Neck

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“…It is well established that women who receive BCS with RT have the same survival as women who receive MRM (Fisher et al 2002; Veronesi et al 2002). It is also well established that women who do not receive SOC (by choice or due to other reasons) have decreased survival particularly among the elderly who, as in this study, are also less likely to meet SOC (Bouchardy et al 2003; Joseph et al 2012; Schonberg et al 2010; Verkooijen et al 2005; Yood et al 2008). BCS with RT is often considered a preferable treatment with less risk during surgery, with less complex reconstruction after surgery leaving more of the breast intact, thus better cosmetic outcomes (Arroyo and Lopez 2011; National Institute of Health Consensus Development Panel 1992).…”

Section: Discussionmentioning

confidence: 56%

Patterns of Care for Localized Breast Cancer in Oklahoma, 2003–2006

et al. 2015

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Despite well-established clinical guidelines for breast cancer treatment, Standard of Care (SOC) is not universal in the U.S. The purpose of this study was to describe the extent to which patients receive guideline-based, stage-specific treatments for localized female breast cancer in Oklahoma. Data were obtained from the Oklahoma Central Cancer Registry for the period 2003–2006. We included localized, invasive female breast cancers and analyzed both treatment and demographic factors. We used the National Comprehensive Cancer Network (NCCN) treatment guidelines to determine SOC. Among women who received breast conserving surgery (BCS), we used logistic regression to evaluate factors related to SOC. In Oklahoma, 92 percent of the 4,177 localized breast cancer patients were treated with recognized SOC. In women aged ≥65 years with BCS, those ≥75 years had a lower adjusted odds of meeting SOC than did those without insurance, with comorbid conditions, or whose comorbid status was unknown. Among women aged <65 years, those with Medicare/Medicaid, Medicare only, or without insurance, along with comorbid conditions, had a lower adjusted odds of meeting SOC. Overall, 92 percent of women met SOC. Factors such as age, insurance type, and comorbid conditions were associated with meeting SOC.

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Outcome analysis of breast cancer patients who declined evidence-based treatment

Cited by 65 publications

References 8 publications

Epidemiologic evidence of slow growing, nonprogressive or regressive breast cancer: A systematic review

Epidemiologic evidence of slow growing, nonprogressive or regressive breast cancer: A systematic review

Factors predicting for patient refusal of head and neck cancer therapy

Patterns of Care for Localized Breast Cancer in Oklahoma, 2003–2006

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