Details:

Alternative Title:
Ann Surg
Personal Author:
Wapnir, Irene L. ; Kurian, Allison W. ; Lichtensztajn, Daphne Y. ; Clarke, Christina A. ; Gomez, Scarlett L.
Wapnir, Irene L. ; Kurian, Allison W. ; Lichtensztajn, Daphne Y. ; Clarke, Christina A. ; Gomez, Scarlett L. Less -
Description:
Background

Neoadjuvant chemotherapy (NAC) for operable breast cancer (BC) can downstage disease and facilitate breast conservation.

Objective

To assess trends in NAC use and surgical procedures in California from 1/1/1998 to 12/31/2012 using statewide population-based cancer registry data.

Methods

236,797 women diagnosed with stage I–III BC were studied. Information regarding NAC, adjuvant chemotherapy (aCT), breast conserving surgery (BCS), bilateral mastectomy (BLM) and unilateral mastectomy (ULM) was abstracted from the medical records. Multivariable polytomous logistic regression were used to estimate odds ratios (OR) of receiving NAC and of type of surgery after NAC.

Results

40.1% (94,980) of patients received chemotherapy: 87% (82,588) aCT and 13.0% (12,392) NAC. NAC use more than doubled over time and increased with stage (Stage I, 0.7%; Stage III, 29.9%). Multivariable predictors of NAC treatment were stage (III), younger age (<40 years), Black or Hispanic race/ethnicity [versus non-Hispanic-white, OR 1.10, 95% confidence interval (CI) 1.05–1.16], and care at a National Cancer Institute (NCI)-designated center (OR 1.70, CI 1.58–1.82). Most (68.4%) NAC recipients had mastectomies, and 14.3% of them underwent BLM. In contrast, 47.9% aCT patients had mastectomies with 7.3% BLM. The only independent predictor of BCS after NAC was care at a NCI-designated center (OR 1.28, CI 1.10–1.49), and of BLM, age <40 (vs. 50–64, OR 2.59, CI 2.21–3.03), or residence in the highest socioeconomic neighborhood quintile (vs. lowest, OR 2.10, CI 1.67–2.64).

Conclusion

NAC use remains low. Predictors of surgery type after NAC were sociodemographic rather than clinical, raising concern for disparities in care access.


Subjects:
[+]
Adult Aged Article Breast Neoplasms California Chemotherapy, Adjuvant Female Humans Mastectomy Mastectomy, Segmental Middle Aged Neoadjuvant Therapy Neoplasm Staging Socioeconomic Factors
Source:
Ann Surg. 266(2):353-360.
Pubmed ID:
27611617
Pubmed Central ID:
PMC5629002
Document Type:
Journal Article
Funding:
HHSN261201000140C/CA/NCI NIH HHS/United States ; HHSN261201000035C/CA/NCI NIH HHS/United States ; HHSN261201000036C/CA/NCI NIH HHS/United States ; U58 DP000807/DP/NCCDPHP CDC HHS/United States ; HHSN261201000035I/CA/NCI NIH HHS/United States ; ... More +
HHSN261201000140C/CA/NCI NIH HHS/United States ; HHSN261201000035C/CA/NCI NIH HHS/United States ; HHSN261201000036C/CA/NCI NIH HHS/United States ; U58 DP000807/DP/NCCDPHP CDC HHS/United States ; HHSN261201000035I/CA/NCI NIH HHS/United States ; HHSN261201000034C/CA/NCI NIH HHS/United States ; U01 CA197282/CA/NCI NIH HHS/United States Less -
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:9ed83d42eaaa8e3b0f44be0b75590f3c4516c2afe5f3c41dda44aec2bee37c57
Download URL:
https://stacks.cdc.gov/view/cdc/48961/cdc_48961_DS1.pdf
File Type:

Supporting Files

• 	nihms908598f3.gif	gif
  	nihms908598f3.jpg	jpeg
  	nihms908598f4.gif	gif
  	nihms908598f4.jpg	jpeg
  	NIHMS908598-supplement-Supplemental_Data_File_1.docx	docx
  	NIHMS908598-supplement-Supplemental_Data_File_2.pdf	pdf
  	NIHMS908598-supplement-Supplemental_Data_File_3.docx	docx
  	nihms908598.nxml	xml
  	nihms908598f1.gif	gif
  	nihms908598f1.jpg	jpeg
  	nihms908598f2.gif	gif
  	nihms908598f2.jpg	jpeg

More +