Mortality impact of less-than-standard therapy in older breast cancer patients

The purpose of this study was to compare the rates of all-cause and breast cancer-specific mortality after breast-conserving surgery (BCS) only, BCS plus radiation therapy (RT), mastectomy, and the receipt of adjuvant tamoxifen in a large population-based cohort of older women with early-stage disea...

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Bibliographic Details
Published in:Journal of the American College of Surgeons Vol. 206; no. 1; p. 66
Main Authors: Yood, Marianne Ulcickas, Owusu, Cynthia, Buist, Diana S M, Geiger, Ann M, Field, Terry S, Thwin, Soe Soe, Lash, Timothy L, Prout, Marianne N, Wei, Feifei, Quinn, Virginia P, Frost, Floyd J, Silliman, Rebecca A
Format: Journal Article
Language:English
Published: United States 01.01.2008
Subjects:
Aged
Aged, 80 and over
Antineoplastic Agents, Hormonal - therapeutic use
Breast Neoplasms - mortality
Breast Neoplasms - pathology
Breast Neoplasms - therapy
Female
Follow-Up Studies
Humans
Mastectomy - methods
Neoplasm Staging
Proportional Hazards Models
Radiotherapy, Adjuvant - methods
Retrospective Studies
Survival Rate - trends
Tamoxifen - therapeutic use
Treatment Outcome
United States - epidemiology
United States
ISSN:1879-1190, 1879-1190
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Summary:The purpose of this study was to compare the rates of all-cause and breast cancer-specific mortality after breast-conserving surgery (BCS) only, BCS plus radiation therapy (RT), mastectomy, and the receipt of adjuvant tamoxifen in a large population-based cohort of older women with early-stage disease. This cohort study was conducted within six US integrated health-care delivery systems. Automated administrative databases, medical records, and tumor registries were used to identify women aged 65 years or older who received BCS or mastectomy to treat stage I or II breast cancer diagnosed from January 1, 1990, through December 31, 1994. We compared cause-specific 10-year mortality rates across treatment categories by fitting Cox proportional hazards models adjusted for demographics and tumor characteristics. We identified 1,837 women having operations for stage I or II breast cancer. Compared with women receiving mastectomy, those receiving BCS without RT were twice as likely to die of breast cancer (adjusted hazards ratio [HR]=2.19, 95% confidence interval [CI], 1.51 to 3.18). Breast cancer mortality rates were similar between women receiving BCS plus RT and women receiving mastectomy (adjusted HR=1.08, 95% CI, 0.79 to 1.48). In the subset of 886 chemotherapy-naive women treated with tamoxifen, those treated with tamoxifen for less than 1 year had a substantially higher breast cancer mortality rate than those exposed 5 years or more (adjusted HR=6.26, 95% CI, 3.10 to 12.64). Our findings indicate that older women receiving BCS alone have higher rates of breast cancer death than those receiving BCS + RT or mastectomy and that the survival benefit from tamoxifen increases with increasing duration of treatment.
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ISSN:1879-1190
1879-1190
DOI:10.1016/j.jamcollsurg.2007.07.015