Document Detail

Mortality impact of less-than-standard therapy in older breast cancer patients.
MedLine Citation:
PMID:  18155570     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: 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. STUDY DESIGN: 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. RESULTS: 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). CONCLUSIONS: 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.
Marianne Ulcickas Yood; Cynthia Owusu; Diana S M Buist; Ann M Geiger; Terry S Field; Soe Soe Thwin; Timothy L Lash; Marianne N Prout; Feifei Wei; Virginia P Quinn; Floyd J Frost; Rebecca A Silliman
Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural     Date:  2007-10-03
Journal Detail:
Title:  Journal of the American College of Surgeons     Volume:  206     ISSN:  1879-1190     ISO Abbreviation:  J. Am. Coll. Surg.     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2007-12-24     Completed Date:  2008-01-08     Revised Date:  2009-05-21    
Medline Journal Info:
Nlm Unique ID:  9431305     Medline TA:  J Am Coll Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  66-75     Citation Subset:  AIM; IM    
Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA.
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MeSH Terms
Aged, 80 and over
Antineoplastic Agents, Hormonal / therapeutic use*
Breast Neoplasms / mortality*,  pathology,  therapy*
Follow-Up Studies
Mastectomy / methods*
Neoplasm Staging
Proportional Hazards Models
Radiotherapy, Adjuvant / methods
Retrospective Studies
Survival Rate / trends
Tamoxifen / therapeutic use
Treatment Outcome
United States / epidemiology
Grant Support
R01 CA093772/CA/NCI NIH HHS; U19 CA079689/CA/NCI NIH HHS
Reg. No./Substance:
0/Antineoplastic Agents, Hormonal; 10540-29-1/Tamoxifen
Comment In:
J Am Coll Surg. 2008 Jun;206(3):1240   [PMID:  18501828 ]

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