United States Trends in the Surgical Treatment of Primary Breast Cancer

Tuttle, Todd M.; Rueth, Natasha M.; Abbott, Andrea M.; Virnig, Beth A

doi:10.1007/s00268-012-1469-4

Cited by 7 publications

(4 citation statements)

References 60 publications

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“…7,[9][10][11][12][13][14][15][16][17][18][19][20][21][22]26,37 While randomized controlled trials and meta-analyses are considered the gold standard for clinical evidence, results and recommendations may not always translate or apply in the same way to community practice where non-selective patient care occurs in environments very different from the controlled, clinical trial environment. Before adjustment, our results were similar whether we compared BCS and mastectomy or BCS with radiation and mastectomy without radiation, likely because the BCS group was affected by selection of adjuvant therapies post-procedure that were consequences of selection of the surgical procedure itself.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8] In recent years, however, mastectomy rates appear to have increased for a variety of reasons, including larger tumor size, multicentric breast cancer, family history, race, younger age at diagnosis, preoperative magnetic resonance imaging utilization, socioeconomic status, distance from a radiation facility, patient preference, provider preference, surgeon volume and specialty training, and availability of and advances in reconstructive surgery. 7,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] These factors and the lack of a well-accepted distinction between the effect of the surgical approach itself and associated adjuvant therapy on outcomes have resulted in patients receiving widely variable surgical approaches, as ideas about surgical impact may have been merged with choices regarding use of adjuvant therapies, including radiation therapy, chemotherapy, and endocrine therapy.…”

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confidence: 99%

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Survival Comparisons for Breast Conserving Surgery and Mastectomy Revisited: Community Experience and the Role of Radiation Therapy

Onitilo

Engel

Stankowski

et al. 2014

Clinical Medicine & Research

117

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Objectives: Evidence suggests superiority of breast conserving surgery (BCS) plus radiation over mastectomy alone for treatment of early stage breast cancer. Whether the superiority of BCS plus radiation is related to the surgical approach itself or to the addition of adjuvant radiation therapy following BCS remains unclear. Materials and Methods:We conducted a retrospective cohort study of women with breast cancer diagnosed from 1994-2012. Data regarding patient and tumor characteristics and treatment specifics were captured electronically. Kaplan-Meier survival analyses were performed with inverse probability of treatment weighting to reduce selection bias effects in surgical assignment.Results: Data from 5335 women were included, of which two-thirds had BCS and one-third had mastectomy. Surgical decision trends changed over time with more women undergoing mastectomy in recent years. Women who underwent BCS versus mastectomy differed significantly regarding age, cancer stage/grade, adjuvant radiation, chemotherapy, and endocrine treatment. Overall survival was similar for BCS and mastectomy. When BCS plus radiation was compared to mastectomy alone, 3-, 5-, and 10-year overall survival was 96.5% vs 93.4%, 92.9% vs 88.3% and 80.9% vs 67.2%, respectively. Conclusion:These analyses suggest that survival benefit is not related only to the surgery itself, but that the prognostic advantage of BCS plus radiation over mastectomy may also be related to the addition of adjuvant radiation therapy. This conclusion requires prospective confirmation in randomized trials.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Survival Comparisons for Breast Conserving Surgery and Mastectomy Revisited: Community Experience and the Role of Radiation Therapy

Onitilo

Engel

Stankowski

et al. 2014

Clinical Medicine & Research

117

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“…The incidence rate was reported as increasing, particularly in low-and middle-income countries (2). While the management of breast cancer has advanced from molecular studies to clinical outcome, the standard treatments for breast cancer are still based on surgery with improvement of tissue conserved, radiation and addition of chemotherapy both cytotoxic and targeted types, in the advance stages (3,4). Breast cancer has a shown variety of cellular marker protein expressions which could determine responses to chemical treatment, for example, the estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2), all of which may be considered as targets for effective therapies (5).…”

Section: Introductionmentioning

confidence: 99%

The trefoil factor 1 (TFF1) protein involved in doxorubicin-induced apoptosis resistance is upregulated by estrogen in breast cancer cells

et al. 2013

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Trefoil factor 1 (TFF1) is a small secretory protein expressed in various types of carcinomas including breast cancer. The TFF1 gene contains an estrogen response element and its expression can be regulated by estrogen. Previous reports showed that TFF1 could protect cells from induced apoptosis in vitro. In the present study, the effect of estrogen on the promotion of doxorubicin-induced apoptosis resistance and the role of TFF1 in this process was demonstrated using the MCF-7 breast cancer cell model. Stable knockdown of the TFF1 gene in MCF-7 cells was generated and used to test the sensitivity to doxorubicin treatment compared to mock control cells in the presence or absence of 17β-estradiol. The apoptotic cells were measured by flow cytometry. The results showed that with the stimulation of apoptosis by doxorubicin, 17β-estradiol could suppress this process in mock cells but not in TFF1 knockdown cells. Moreover, using a viable cell counting method, it was shown that the anti-TFF1 antibody could reverse the anti-apoptotic effect of estrogen in mock cells and recombinant TFF1 could recover doxorubicin-induced cell death in TFF1 knockdown cells. This process, however, could not be inhibited by fulvestrant, an estrogen antagonist. An apoptosis protein array experiment reflected the role of the anti-oxidative enzyme catalase in estrogen and TFF1-modulated apoptosis and this was confirmed by enzymatic assay. These phenomena determine the role of TFF1 in estrogen-promoted resistance to apoptosis induced by doxorubicin in MCF-7 breast cancer cells. The TFF1 gene may be a target for enhancing the sensitivity to chemotherapy in breast cancer treatment.

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“…Overall, our findings highlight a potential larger issue-men with breast cancer are often excluded unnecessarily from potentially practice-changing and/or life-saving therapies until results are published. Furthermore, the routine uptake of evidence into clinical practice may take years in the best circumstances, 16 and this may impact outcomes for men with breast cancer, although additional studies would be needed to explore this potential association.…”

Section: Discussionmentioning

confidence: 99%

Surgery for Men with Breast Cancer: Do the Same Data Still Apply?

et al. 2020

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Background.-Men represent a small proportion of breast cancer diagnoses, and they are often excluded from clinical trials. Current treatments are largely extrapolated from evidence in women. We compare practice patterns between men and women with breast cancer following the publication of several landmark clinical trials in surgery.Patients and Methods.-Patients with invasive breast cancer (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) from the National Cancer Data Base were identified; subcohorts were created based on eligibility for NSABP-B06, CALGB 9343, and ACOSOG Z0011. Practice patterns were stratified by gender and compared. Cox proportional hazards regression analyses were utilized to estimate the association between OS and gender.Results.-Of the 1,664,746 patients identified, 99% were women and 1% were men. Among NSABP-B06 eligible men, mastectomy rates did not change (consistently ~ 80%), and their adjusted OS was minimally worse compared with women (HR 1.19, 95% CI 1.11-1.28).

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United States Trends in the Surgical Treatment of Primary Breast Cancer

Cited by 7 publications

References 60 publications

Survival Comparisons for Breast Conserving Surgery and Mastectomy Revisited: Community Experience and the Role of Radiation Therapy

Survival Comparisons for Breast Conserving Surgery and Mastectomy Revisited: Community Experience and the Role of Radiation Therapy

The trefoil factor 1 (TFF1) protein involved in doxorubicin-induced apoptosis resistance is upregulated by estrogen in breast cancer cells

Surgery for Men with Breast Cancer: Do the Same Data Still Apply?

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