Variation in Contralateral Prophylactic Mastectomy Rates According to Racial Groups in Young Women with Breast Cancer, 1998 to 2011: A Report from the National Cancer Data Base

Grimmer, Laura; Liederbach, Erik; Velasco, José Antonio Noguera; Pesce, Catherine; Wang, Chi‐Hsiung; Yao, Katharine

doi:10.1016/j.jamcollsurg.2015.03.033

Cited by 55 publications

(65 citation statements)

References 39 publications

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“…This trend has been observed previously among woman <45 years of age diagnosed with early stage breast cancer. 33 Previous research has also shown similar prevalence of BRCA1/2 mutations among breast cancer patients of European, African, and Hispanic ancestry. 34 Mammography screening rates appear to be higher among women of European ancestry.…”

Section: Discussionmentioning

confidence: 84%

Emerging trends in surgical and adjuvant radiation therapies among women diagnosed with ductal carcinoma in situ

Shiyanbola

Sprague

Hampton

et al. 2016

Cancer

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BACKGROUND The use of surgery and radiation therapy in treating ductal carcinoma in situ (DCIS) is directed by treatment guidelines and evidence from research. We sought to investigate recent patterns in DCIS treatment by demographic factors. METHODS Data for women diagnosed with DCIS between 1998 and 2011 (n = 416,232) in the National Cancer Data Base were assessed for trends in treatment patterns by age group, calendar year, ancestral/ethnic group and geographic region. The likelihood of receiving specific treatment modalities was analyzed using multivariable logistic regression. RESULTS DCIS cases were most frequently treated with breast conserving surgery (BCS) and adjuvant radiation (45.6%). After an initial rise, the use of adjuvant radiation following BCS plateaued at around 70% after 2007, with increasing utilization of mastectomy beyond 2005. Additionally, there was an increasing trend in post-mastectomy reconstruction over time, and women of African ancestry (odds ratio, 0.69; 95% confidence interval,0.66–0.72) and Hispanic women were less likely to undergo reconstruction (odds ratio, 0.83; 95% confidence interval, 0.78–0.89) compared to women of European ancestry. A similar trend was observed in contralateral risk reducing mastectomy utilization, with women of European ancestry having a more rapid rise in the utilization of contralateral risk reducing mastectomy among all ancestral/ethnic groups. CONCLUSION Recent trends demonstrate a plateau in radiation therapy administration following BCS, with increasing utilization of mastectomy, reconstruction and contralateral risk reducing mastectomy. There are substantial differences in treatment utilization according to ancestry/ethnicity and geographical region. Further studies examining patient-physician decision making surrounding DCIS treatment are warranted.

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Section: Discussionmentioning

confidence: 84%

Emerging trends in surgical and adjuvant radiation therapies among women diagnosed with ductal carcinoma in situ

Shiyanbola

Sprague

Hampton

et al. 2016

Cancer

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“…While disparities in oncologic treatments and outcomes by patient race and insurance status have been consistently demonstrated in the published literature, 11–14 whether rates of guideline-concordant care differ by where breast cancer patients receive treatment have not been fully described. A study by Cliby et al used NCDB data to show that treatment at an academic center was independently associated with a higher rate of guideline-concordant care for ovarian cancer.…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant Systemic Therapy Use for Younger Patients with Breast Cancer Treated in Different Types of Cancer Centers Across the United States

Mohiuddin

Deal

Carey

et al. 2016

Journal of the American College of Surgeons

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Background Multiple clinical trials have shown that neoadjuvant systemic therapy has a benefit in women who are borderline lumpectomy candidates and in those with locally-advanced breast cancers by reducing the mastectomy rate and making inoperable tumors operable. The study aim was to examine the patterns of neoadjuvant chemotherapy and endocrine therapy use among younger women in the US treated at different types of cancer centers. Study Design Data from the National Cancer Data Base for 118,086 women younger than 65 with clinical stage IIA (T2N0 only) to IIIC breast cancer. Following the National Comprehensive Cancer Network guideline categorization, patients were grouped into those who were borderline lumpectomy candidates (clinical stage IIA [T2N0 only], IIB, or IIIA [T3N1 only]) or those with locally-advanced disease (clinical stage IIIA [T0-3N2 only], IIIB, or IIIC). The main outcome was the proportion of women who received neoadjuvant systemic therapy. Results Use of neoadjuvant chemotherapy ranged from 17% (stage IIA) to 79% (stage IIIB). Across almost all stage and receptor subtypes, the use was lower in community vs. academic centers. On multivariable analysis, use of neoadjuvant chemotherapy was decreased in community vs. academic centers (borderline lumpectomy candidates, aRR 0.73, 95% CI 0.69–0.77; locally-advanced disease, aRR 0.78, 95% CI 0.74–0.83). Conclusions Use of guideline-concordant neoadjuvant chemotherapy is significantly higher among women treated at academic vs. community centers in young and healthy women who do not commonly have contraindications to this treatment. Our study identified a potential disparity in cancer care by type of center where patients receive treatment.

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“…Community education status was designated by the proportion of zip‐code residents without a high school diploma, and income was area‐based, with measurements calculated from data based on the patient's zip code. Using the area‐based indicators of income and education, a socioeconomic (SES) variable was created to describe patients living in low, middle and high SES areas as previously described . Patients living in the lowest quartile income and education areas were classified as low SES, and patients living in the highest quartile income and education areas were classified as high SES.…”

Section: Methodsmentioning

confidence: 99%

The national landscape of human papillomavirus-associated oropharynx squamous cell carcinoma

et al. 2016

Self Cite

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The head and neck squamous cell carcinoma (HNC) landscape is evolving with human papillomavirus (HPV) being a rising cause of oropharynx carcinoma (OPC). This study seeks to investigate a national database for HPV-associated oropharynx carcinoma (HPV-OPC). Using the National Cancer Data Base, we analyzed 22,693 patients with HPV-OPC and known HPV status. Chi-square tests and logistic regression models were utilized to examine differences between HPV positive and HPV negative OPC. 14,805 (65.2%) patients were HPV positive. Mean age at presentation was 58.4 years with HPV-HNC patients being 2.8 years younger compared to the HPV-negative cohort (58.4 vs. 61.2 years, p < 0.001). 67.6% of white patients were HPV-positive compared to 42.3% of African American patients and 57.1% of Hispanics (p < 0.001). When combining race and socioeconomic status (SES), we found African American patients in high SES groups had HPV-OPC prevalence that was significantly higher than African American patients in low SES groups (56.9% vs. 36.3%, p < 0.001). Geographic distribution of HPV-OPC was also analyzed and found to be most prevalent in Western states and least prevalent in the Southern states (p < 0.001). The distribution of HPV-OPC is variable across the country and among racial and socioeconomic groups. A broad understanding of these differences in HPV-OPC should drive educational programs and improve clinical trials that benefit both prevention and current treatments.

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Variation in Contralateral Prophylactic Mastectomy Rates According to Racial Groups in Young Women with Breast Cancer, 1998 to 2011: A Report from the National Cancer Data Base

Cited by 55 publications

References 39 publications

Emerging trends in surgical and adjuvant radiation therapies among women diagnosed with ductal carcinoma in situ

Emerging trends in surgical and adjuvant radiation therapies among women diagnosed with ductal carcinoma in situ

Neoadjuvant Systemic Therapy Use for Younger Patients with Breast Cancer Treated in Different Types of Cancer Centers Across the United States

The national landscape of human papillomavirus-associated oropharynx squamous cell carcinoma

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