VARIATION IN LOCOREGIONAL TREATMENT OF STAGE I – II BREAST CANCER BY BREAST SUBTYPE IN NONELDERLY ADULT WOMEN
Author(s)
Voelker J1, Alcusky M2, Singer D1, Mitchell E3, Delgado D1
1Jefferson College of Population Health at Thomas Jefferson University, Philadelphia, PA, USA, 2University of Massachusetts Medical School, Worcester, MA, USA, 3Sidney Kimmel Cancer Center of Thomas Jefferson University, Philadelphia, PA, USA
OBJECTIVES: Breast cancer treatment guidelines recommend locoregional treatment consisting of breast-conserving surgery (BCS) plus radiation therapy (RT) or mastectomy (M) for Stage I-II female breast cancer. This study examines the relationship of breast subtype with locoregional treatment. METHODS: The Surveillance, Epidemiology, and End Results Program registry database was used to evaluate females age 18-64 years diagnosed from 2010-2013 with Stage I-II breast cancer. The exposure of interest was breast subtype: HR+/Her2-, HR+/Her2+, HR-/Her2+, or HR-/Her2-. The outcome of interest was locoregional treatment: BCS+RT, BCS alone, M+RT, or mastectomy alone. The population was stratified by age (18-44 years and 45-64 years) and race/ethnicity (non-Hispanic (NH) white, NH black, NH Asian/Pacific Islander, and Hispanic). Multinomial logistic models were fit within each strata to determine the association between breast subtype and locoregional treatment, adjusting for demographic and clinical variables. RESULTS: 84,111 patients were included. Compared to women with HR+/Her2- cancers, the odds (OR, 95% CI) of receiving BCS alone versus BCS+RT were increased among NH whites (1.57, 1.01-2.43) and NH blacks (2.53, 1.26-5.08) with HR-/Her2+ cancers. NH whites with HR+/Her2+ and HR-/Her2+ had increased odds of receiving M+RT versus BCS+RT (1.49, 1.22-1.82 and 1.94, 1.36-2.79, respectively). Women with Her2+ tumors had increased odds of receiving mastectomy alone versus BCS+RT, regardless of race/ethnicity. NH whites, NH blacks, and Hispanics with HR-/Her2+ tumors had increased odds of receiving M+RT versus BCS+RT (2.17, 1.79-2.63; 1.53, 1.05-2.23; and 1.57, 1.03-2.39, respectively), but this relationship was not observed among NH Asian/Pacific Islanders. CONCLUSIONS: Variability in surgical and radiation therapy treatment patterns was observed by breast subtype across race/ethnicity strata and between age groups. Additional research is needed to understand how breast subtype is and should be considered by patients and providers in locoregional treatment decisions.
Conference/Value in Health Info
2018-05, ISPOR 2018, Baltimore, MD, USA
Value in Health, Vol. 21, S1 (May 2018)
Code
PCN177
Topic
Epidemiology & Public Health, Health Policy & Regulatory, Health Service Delivery & Process of Care, Patient-Centered Research, Study Approaches
Topic Subcategory
Health Disparities & Equity, Hospital and Clinical Practices, Patient Behavior and Incentives, Public Health, Quality of Care Measurement, Registries, Treatment Patterns and Guidelines
Disease
Oncology
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