BACKGROUND: Although breast conservation therapy (BCT) is standard for breast cancer treatment, patients with tumors measuring >5 cm have been excluded from clinical trials. Nevertheless, only a few small retrospective series to date have compared BCT with mastectomy for tumors measuring >5 cm. The current study was performed to determine whether survival is equivalent for BCT versus mastectomy using a large national data set. METHODS: Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked cases were identified for patients aged ≥ 66 years undergoing breast conservation for invasive, noninflammatory, nonmetastatic breast cancer between 1992 and 2009. Propensity score-based adjustment was used to account for demographics and tumor and treatment factors. RESULTS: A total of 5685 patients with tumors measuring >5.0 cm underwent breast surgery, with 15.6% receiving BCT. Mean ages of the patients and tumor sizes were similar. Predictors of BCT included neoadjuvant chemotherapy and postoperative radiotherapy use, higher income, breast cancer as a first malignancy, and a higher Charlson Comorbidity Index. Predictors of mastectomy included younger age, nonductal histology, higher grade, numbers of lymph nodes examined and found to be positive, American Joint Committee on Cancer stage III disease, postoperative chemotherapy use, and residential region of the country. Adjusted overall and breast cancer-specific survival were not different between patients treated with BCT and mastectomy (hazard ratio, 0.934; 95% confidence interval, 0.791-1.103 [P = .419] for overall survival; and subdistribution hazard ratio, 1.042; 95% confidence interval, 0.793-1.369 [P = .769] for breast cancer-specific survival), with each improving over time. The median follow-up was 7.0 years. CONCLUSIONS: For Medicare patients with tumors measuring >5 cm, survival is similar between those treated with BCT and mastectomy as for patients with smaller primary tumors. Despite exclusion from randomized trials, BCT may remain an option for patients with larger tumors when deemed clinically and cosmetically amenable to surgical resection.
BACKGROUND: Although breast conservation therapy (BCT) is standard for breast cancer treatment, patients with tumors measuring >5 cm have been excluded from clinical trials. Nevertheless, only a few small retrospective series to date have compared BCT with mastectomy for tumors measuring >5 cm. The current study was performed to determine whether survival is equivalent for BCT versus mastectomy using a large national data set. METHODS: Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked cases were identified for patients aged ≥ 66 years undergoing breast conservation for invasive, noninflammatory, nonmetastatic breast cancer between 1992 and 2009. Propensity score-based adjustment was used to account for demographics and tumor and treatment factors. RESULTS: A total of 5685 patients with tumors measuring >5.0 cm underwent breast surgery, with 15.6% receiving BCT. Mean ages of the patients and tumor sizes were similar. Predictors of BCT included neoadjuvant chemotherapy and postoperative radiotherapy use, higher income, breast cancer as a first malignancy, and a higher Charlson Comorbidity Index. Predictors of mastectomy included younger age, nonductal histology, higher grade, numbers of lymph nodes examined and found to be positive, American Joint Committee on Cancer stage III disease, postoperative chemotherapy use, and residential region of the country. Adjusted overall and breast cancer-specific survival were not different between patients treated with BCT and mastectomy (hazard ratio, 0.934; 95% confidence interval, 0.791-1.103 [P = .419] for overall survival; and subdistribution hazard ratio, 1.042; 95% confidence interval, 0.793-1.369 [P = .769] for breast cancer-specific survival), with each improving over time. The median follow-up was 7.0 years. CONCLUSIONS: For Medicare patients with tumors measuring >5 cm, survival is similar between those treated with BCT and mastectomy as for patients with smaller primary tumors. Despite exclusion from randomized trials, BCT may remain an option for patients with larger tumors when deemed clinically and cosmetically amenable to surgical resection.
Keywords:
breast cancer; breast mortality; breast neoplasms; breast pathology; breast radiotherapy; breast surgery; breast-conserving surgery; clinical practice patterns; feasibility studies; segmental mastectomy; survival rate; treatment outcome
Authors: M Clarke; R Collins; S Darby; C Davies; P Elphinstone; V Evans; J Godwin; R Gray; C Hicks; S James; E MacKinnon; P McGale; T McHugh; R Peto; C Taylor; Y Wang Journal: Lancet Date: 2005-12-17 Impact factor: 79.321
Authors: J A van Dongen; A C Voogd; I S Fentiman; C Legrand; R J Sylvester; D Tong; E van der Schueren; P A Helle; K van Zijl; H Bartelink Journal: J Natl Cancer Inst Date: 2000-07-19 Impact factor: 13.506
Authors: J A Jacobson; D N Danforth; K H Cowan; T d'Angelo; S M Steinberg; L Pierce; M E Lippman; A S Lichter; E Glatstein; P Okunieff Journal: N Engl J Med Date: 1995-04-06 Impact factor: 91.245
Authors: B Fisher; J Bryant; N Wolmark; E Mamounas; A Brown; E R Fisher; D L Wickerham; M Begovic; A DeCillis; A Robidoux; R G Margolese; A B Cruz; J L Hoehn; A W Lees; N V Dimitrov; H D Bear Journal: J Clin Oncol Date: 1998-08 Impact factor: 44.544
Authors: Leonie A E Woerdeman; J Joris Hage; Esther A Thio; Frans A N Zoetmulder; Emiel J Th Rutgers Journal: Plast Reconstr Surg Date: 2004-05 Impact factor: 4.730
Authors: Allen M Chen; Funda Meric-Bernstam; Kelly K Hunt; Howard D Thames; Mary Jane Oswald; Elesyia D Outlaw; Eric A Strom; Marsha D McNeese; Henry M Kuerer; Merrick I Ross; S Eva Singletary; Fredrick C Ames; Barry W Feig; Aysegul A Sahin; George H Perkins; Naomi R Schechter; Gabriel N Hortobagyi; Thomas A Buchholz Journal: J Clin Oncol Date: 2004-06-15 Impact factor: 44.544
Authors: Louise J Jones; Claude Chelala; Emanuela Gadaleta; Pauline Fourgoux; Stefano Pirró; Graeme J Thorn; Rachel Nelan; Alastair Ironside; Vinothini Rajeeve; Pedro R Cutillas; Anna E Lobley; Jun Wang; Esteban Gea; Helen Ross-Adams; Conrad Bessant; Nicholas R Lemoine Journal: NPJ Breast Cancer Date: 2020-08-21
Authors: Anna M Mazor; Alina M Mateo; Lyudmila Demora; Elin R Sigurdson; Elizabeth Handorf; John M Daly; Allison A Aggon; Penny R Anderson; Stephanie E Weiss; Richard J Bleicher Journal: Breast Cancer Res Treat Date: 2018-10-20 Impact factor: 4.872
Authors: Matthew Squires; Yunfei Hu; Mikel Byrne; Ben Archibald-Heeren; Sonja Cheers; Bruno Bosco; Amy Teh; Andrew Fong Journal: J Med Radiat Sci Date: 2017-06-04
Authors: Guilherme Freire Angotti Carrara; Cristovam Scapulatempo-Neto; Lucas Faria Abrahão-Machado; Maria Mitzi Brentani; João Soares Nunes; Maria Aparecida Azevedo Koike Folgueira; René Aloisio da Costa Vieira Journal: Clinics (Sao Paulo) Date: 2017-03 Impact factor: 2.365
Authors: Louise J Jones; Claude Chelala; Emanuela Gadaleta; Pauline Fourgoux; Stefano Pirró; Graeme J Thorn; Rachel Nelan; Alastair Ironside; Vinothini Rajeeve; Pedro R Cutillas; Anna E Lobley; Jun Wang; Esteban Gea; Helen Ross-Adams; Conrad Bessant; Nicholas R Lemoine Journal: NPJ Breast Cancer Date: 2020-08-21
Authors: Mary Kathryn Abel; Case E Brabham; Ruby Guo; Kelly Fahrner-Scott; Jasmine Wong; Michael Alvarado; Cheryl Ewing; Laura J Esserman; Rita A Mukhtar Journal: Am J Surg Date: 2020-06-19 Impact factor: 2.565