Ann Surg

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.

27611617

PMC5629002

Journal Article

CDC Public Access