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Factors Influencing Surgical and Adjuvant Therapy in Stage I Breast Cancer: A SEER 18 Database Analysis

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Randomized trials have shown no survival difference for patients with stage I breast cancer treated with mastectomy versus breast-conserving surgery (BCS) with radiotherapy (RT). RT is recommended after BCS in order to decrease local recurrence and mortality. We sought to evaluate the treatment trends in patients with stage I breast cancer.

Methods

We used the Surveillance, Epidemiology, and End Results (SEER) database to identify 194,860 women with stage I breast cancer diagnosed from 1988 to 2007. We evaluated factors that were associated surgical treatment and the utilization of RT after BCS.

Results

There was a progressive decline in the proportion of patients with stage I breast cancer who were treated with mastectomy from 1998 to 2007. Significant predictors for being treated with mastectomy included single/divorced women (p = 0.007), white race (p < 0.001), estrogen receptor negativity (p < 0.001), earlier year of diagnosis (p < 0.001), smaller tumor size (p < 0.001), and region (p < 0.001). Twenty percent of the BCS cohort did not receive RT, and this proportion did not change over time. Significant predictors for not receiving RT included small tumor size (p < 0.001), African American race (p < 0.001), increasing age (p < 0.001), single/divorced women (p < 0.001), estrogen receptor negativity (p < 0.001), and region (p < 0.001). The survival for patients treated with BCS and RT was significantly higher than for those who did not receive RT (p < 0.001).

Conclusions

The use of BCS for the treatment of stage I breast cancer increased over time. A constant proportion of patients did not receive RT after BCS. Omission of RT in BCS is associated with an increase in mortality.

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Authors and Affiliations

  1. Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA

    Shayna L. Showalter MD & Brian J. Czerniecki MD, PhD

  2. Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA

    Surbhi Grover MD, Sonam Sharma MD & Lillie Lin MD

Authors
  1. Shayna L. Showalter MD
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  2. Surbhi Grover MD
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  5. Brian J. Czerniecki MD, PhD
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Correspondence to Brian J. Czerniecki MD, PhD.

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Showalter, S.L., Grover, S., Sharma, S. et al. Factors Influencing Surgical and Adjuvant Therapy in Stage I Breast Cancer: A SEER 18 Database Analysis. Ann Surg Oncol 20, 1287–1294 (2013). https://doi.org/10.1245/s10434-012-2693-8

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  • DOI: https://doi.org/10.1245/s10434-012-2693-8

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