Trends in Surgical Treatment of Younger Patients With Breast Cancer in Australia and New Zealand

Wang, Jim; Boult, Margaret; Tyson, Sarah; Babidge, Wendy; Zorbas, Helen; Kollias, James; Roder, David; Maddern, Guy J.

doi:10.1111/j.1445-2197.2008.04613.x

Cited by 8 publications

(6 citation statements)

References 27 publications

(37 reference statements)

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“…This study has used data submitted over the last 8 years by breast surgeons in Australia and New Zealand. One previous study has shown that over this period of time, the use of BCS has not changed significantly either overall (27), or for younger women using multivariate models (28). In the multivariate logistic regression analysis, we have checked and ensured that assumptions underlying the logistic modeling, such as a lack of co-linearity, were satisfied.…”

Section: Discussionmentioning

confidence: 99%

Patterns of Surgical Treatment for Women with Breast Cancer in Relation to Age

et al. 2010

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Although treatment recommendations have been advocated for all women with early breast cancer regardless of age, it is generally accepted that different treatments are preferred based on the age of the patient. The aim of this study was to assess the pattern of breast cancer surgery after adjusting for other major prognostic factors in relation to patient age. Data on cancer characteristics and surgical procedures in 31,298 patients with early breast cancer reported to the National Breast Cancer Audit between 1999 and 2006 were used for the study. There was a close association between age and surgical treatment pattern after adjusting for other prognostic factors, including tumor size, histologic grade, number of tumors, lymph node positivity, lymphovascular invasion (LVI), and extensive intraduct component. Breast Conserving Surgery (BCS) was highest among women aged 70 years (OR = 0.498, 95% CI: 0.455-0.545). Significantly more women aged 50 years (11.4-17.0%). Women aged >70 years were more likely to receive no surgical treatment, 3.5% versus 1.0-1.3% in all other age groups (70 years) more commonly undergo mastectomy and are more likely to receive no surgical treatment.

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Section: Discussionmentioning

confidence: 99%

Patterns of Surgical Treatment for Women with Breast Cancer in Relation to Age

et al. 2010

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“…The data support clinical audit by surgeons of their practices and are used for research into breast cancer and its management. [1][2][3][4][5] The Audit's main purpose is to strengthen quality improvement through the promotion of high clinical standards, but it is recognised that cancer outcomes would also be affected by structural features of the health system, potentially including governance structures, resource allocation, service coordination, workforce availability, and access and appropriateness of care. [6][7][8] For example, poor survival from cancer among Aboriginal and Torres Strait Islander patients has been associated with geographic remoteness, cultural differences, socioeconomic and other social factors not adequately accommodated by the health system, rather than technical standards of care delivered.…”

Section: Introductionmentioning

confidence: 99%

Survival from breast cancer: an analysis of Australian data by surgeon case load, treatment centre location, and health insurance status

Roder¹,

Silva²,

Zorbas³

et al. 2012

Aust. Health Review

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Objective. Early invasive breast cancer data from the Australian National Breast Cancer Audit were used to compare case fatality by surgeon case load, treatment centre location and health insurance status.Method. Deaths were traced to 31 December 2007, for cancers diagnosed in 1998-2005. Risk of breast cancer death was compared using Cox proportional hazards regression.Results. When adjustment was made for age and clinical risk factors: (i) the relative risk of breast cancer death (95% confidence limit) was lower when surgeons' annual case loads exceeded 20 cases, at 0.87 (0.76, 0.995) for 21-100 cases and 0.83 (0.72, 0.97) for higher case loads. These relative risks were not statistically significant when also adjusting for treatment centre location (P 0.15); and (ii) compared with major city centres, inner regional centres had a relative risk of 1.32 (1.18, 1.48), but the risk was not elevated for more remote sites at 0.95 (0.74, 1.22). Risk of death was not related to private insurance status.Conclusion. Higher breast cancer mortality in patients treated in inner regional than major city centres and in those treated by surgeons with lower case loads requires further study.What is known about the topic? Studies in some countries show an association of poorer outcomes with lower case load and lack of private health insurance. What does this paper add? Lower survivals apply in contemporary Australian environments where annual case loads are 20 or fewer and for patients treated in inner regional compared with major city centres. Poorer survivals for patients without private health insurance status are not statistically significant after adjusting for tumour size and other risk factors. What are the implications for practitioners? Additional research is needed to determine why survivals are lower in Australian settings where case loads are low and when treatment is provided in inner regional centres. Meanwhile, it would be appropriate to target these settings in quality improvement programs.

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“…An opportunity exists to explore age‐related survivals from early breast cancer using data from the National Breast Cancer Audit (NBCA) of the Royal Australasian College of Surgeons (RACS). These data have been collected since 1998 primarily to support clinical audit by surgeons of their practices 14–16 …”

Section: Introductionmentioning

confidence: 99%

Age effects on survival from early breast cancer in clinical settings in Australia

Roder

Silva

Zorbas

et al. 2012

ANZ Journal of Surgery

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Background: The study aim was to determine whether age is an independent risk factor for survival from early invasive breast cancer in contemporary Australian clinical settings. Methods: The study included 31 493 breast cancers diagnosed in 1998–2005. Risk of death from breast cancer was compared by age, without and with adjustment for clinical risk factors, using Cox proportional hazard regression. Results: Risk of breast cancer death was elevated for cancers of larger size, higher grade, positive nodal status, oestrogen receptor negative status, vascular invasion and multiple foci. Ductal lesions presented a higher risk than other lesions. Adjusting for these factors, the relative risk of breast cancer death (95% confidence limits) was lower for 40–49‐year‐olds at 0.80 (0.66, 0.96) than for the reference category under 40 years, but higher for 70–79‐year‐olds at 1.64 (1.36, 1.98) and women aged 80 years or more at 2.19 (1.79, 2.69). The risk for 50–69‐year‐olds and women under 40 years was similar. Risk‐factor adjustment reduced the difference in risk between the reference category under 40 years and 40–49‐year‐olds, largely eliminated the lower relative risk for 50–69‐year‐olds, and increased the relative risks for women aged 70–79 years and older. Discussion: Survivals in women under 40 and over 70 years of age are poorer than for 40–69‐year‐olds. Research is needed into the best treatment modalities for younger women and older women with co‐morbidity.

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Trends in Surgical Treatment of Younger Patients With Breast Cancer in Australia and New Zealand

Cited by 8 publications

References 27 publications

Patterns of Surgical Treatment for Women with Breast Cancer in Relation to Age

Patterns of Surgical Treatment for Women with Breast Cancer in Relation to Age

Survival from breast cancer: an analysis of Australian data by surgeon case load, treatment centre location, and health insurance status

Age effects on survival from early breast cancer in clinical settings in Australia

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