Abstract
Background
National databases are a rich source of epidemiologic data for breast surgical oncology research. However, these databases differ in the demographic, surgical, and oncologic variables provided. This study aimed to compare the strengths and limitations of four national databases in the context of breast surgical oncology research.
Methods
The study comprised a descriptive analysis of four national databases (the National Surgical Quality Improvement Program [NSQIP], the Nationwide Inpatient Sample [NIS], the Surveillance, Epidemiology and End Results [SEER] program, and the National Cancer Database [NCDB]) to assess their strengths and limitations in the context of breast surgical oncology. The study assessed the data available in each database for female patients with a breast cancer diagnosis between 2007 and 2017, and compared patient age, ethnicity, and race distributions.
Results
Data from 3.9 million female patients were examined, with most patients being between 60 and 69 years of age, non-Hispanic, and white. Age, ethnicity, and race distributions were similar in the databases. The NSQIP includes data on operative details, comorbidities, and postoperative outcomes. The NIS provides health services and inpatient utilization information, but does not evaluate outpatient procedures. The SEER program provides population-based oncologic detail including stage, histology, and neoadjuvant/adjuvant treatment. The NCDB offers hospital-based oncologic information and the largest population in the study period, with approximately 2.5 million breast cancer patients.
Conclusion
Epidemiologic datasets offer tremendous potential for the examination of oncologic breast surgery, with each database providing unique data useful for addressing different epidemiologic questions. Understanding the strengths and limitations of each database creates a more efficient and productive research environment.
Similar content being viewed by others
References
Surgeons Aco. ACS National Surgical Quality Improvement Program. https://www.facs.org/quality-programs/acs-nsqip. Accessed 1 Oct 2021.
Surgeons Aco. ACS NSQIP History. https://www.facs.org/quality-programs/acs-nsqip/about/history. Accessed 1 Oct 2021.
Surgeons Aco. ACS National Surgical Quality Improvement Program. https://www.facs.org/quality-programs/acs-nsqip. Accessed 21 July 2021.
Surgeons Aco. About ACS NSQIP. https://www.facs.org/quality-programs/acs-nsqip/about. Accessed 1 Dec 2021.
(HCUP) HDHCaUP. Overview of the National (Nationwide) Inpatient Sample (NIS). 2021. https://www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed 1 Oct 2021.
(HCUP) HDHCaUP. 2012 NIS Redesign Report Available on HCUP Website (May 2014). 2014 https://www.hcup-us.ahrq.gov/news/announcements/nisredesign_2012.jsp. Accessed 1 Oct 2021.
(HCUP) HDHCaUP. Introduction to the HCUP National Inpatient Sample (NIS), 2017. 2020. https://www.hcup-us.ahrq.gov/db/nation/nis/NIS_Introduction_2017.jsp#table2app1. Accessed 1 Oct 2021.
National Cancer Institute S, Epidemiology, and End Results Program. Overview of the SEER Program. https://seer.cancer.gov/about/overview.html. Accessed 1 Oct 2021.
National Cancer Institute S, Epidemiology, and End Results Program. Goals of the SEER Program. https://seer.cancer.gov/about/goals.html. Accessed 1 Oct 2021.
Surgeons Aco. National Cancer Database. https://www.facs.org/quality-programs/cancer/ncdb. Accessed 1 Oct 2021.
Mohanty S, Bilimoria KY. Comparing national cancer registries: the National Cancer Data Base (NCDB) and the Surveillance, Epidemiology, and End Results (SEER) program. J Surg Oncol. 2014;109:629–30.
Mettlin CJ, Menck HR, Winchester DP, Murphy GP. A comparison of breast, colorectal, lung, and prostate cancers reported to the National Cancer Data Base and the Surveillance, Epidemiology, and End Results program. Cancer. 1997;79:2052–61.
Winchester DP, Stewart AK, Bura C, Jones RS. The National Cancer Data Base: a clinical surveillance and quality improvement tool. J Surg Oncol. 2004;85:1–3.
Bilimoria KY, Stewart AK, Winchester DP, Ko CY. The National Cancer Data Base: a powerful initiative to improve cancer care in the United States. Ann Surg Oncol. 2008;15:683–90.
Feig B. Comprehensive databases: a cautionary note. Ann Surg Oncol. 2013;20:1756–8.
Lerro CC, Robbins AS, Phillips JL, Stewart AK. Comparison of cases captured in the National Cancer Database with those in population-based central cancer registries. Ann Surg Oncol. 2013;20:1759–65.
Bohl DD, Basques BA, Golinvaux NS, Baumgaertner MR, Grauer JN. Nationwide Inpatient Sample and National Surgical Quality Improvement Program give different results in hip fracture studies. Clin Orthop Relat Res. 2014;472:1672–80.
Kwaan MR. Using NSQIP as a research tool: how to answer questions that are not amenable to local data. Semin Colon Rectal Surg. 2016;27:83–6.
Alluri RK, Leland H, Heckmann N. Surgical research using national databases. Ann Transl Med. 2016;4:393.
Boffa DJ. Using the National Cancer Database for outcomes research: a review. JAMA Oncol. 2017;3:1722–8.
Mallin K, Browner A, Palis B, et al. Incident cases captured in the National Cancer Database compared with those in U.S. population-based central cancer registries in 2012–2014. Ann Surg Oncol. 2019;26:1604–12.
McCabe RM. National Cancer Database: the past, present, and future of the Cancer Registry and its efforts to improve the quality of cancer care. Semin Radiat Oncol. 2019;29:323–5.
Janz TA, Graboyes EM, Nguyen SA, et al. A comparison of the NCDB and SEER database for research involving head and neck cancer. Otolaryngol Head Neck Surg. 2019;160:284–94.
Surgeons Aco. ACS NSQIP Participant Use Data File. Retrieved 1 October at https://www.facs.org/quality-programs/acs-nsqip/participant-use.
National Cancer Institute S, Epidemiology, and End Results Program. How to Request Access to SEER Data. 1 October 2021 at https://seer.cancer.gov/data/access.html.
National Cancer Institute S, Epidemiology, and End Results Program. SEER*Stat Databases: November 2020 submission. Retrieved 1 October 2021 at https://seer.cancer.gov/data-software/documentation/seerstat/nov2020/#ss-variables.
National Cancer Institute S, Epidemiology, and End Results Program. Registry Groupings in SEER Data and Statistics. Retrieved 1 October 2021 at https://seer.cancer.gov/registries/terms.html.
Surgeons Aco. Participant User Files. Retrieved 1 October 2021 at https://www.facs.org/quality-programs/cancer/ncdb/puf.
National Cancer Institute S, Epidemiology, and End Results Program. Scope of Regional Lymph Node Surgery. Retrieved 25 May 2022 at https://seer.cancer.gov/seerstat/variables/seer/regional_ln/.
American college of Surgeons NCD. National Cancer Database Participant User File, 2017 Data Dictionary, Includes patients diagnosed in 2004–2017. 2020; pp 139–44. Retrieved 25 May 2022 at: https://www.facs.org/media/khro23pr/puf_data_dictionary_2017.pdf.
Fritz AG. International Classification of Diseases for Oncology: ICD-O. 3rd edn. Geneva: First revision. World Health Organization; 2013.
(HCUP) HHCaUP. Healthcare Cost and Utilization Project (HCUP) Recommendations for Reporting Trends using ICD-9-CM and ICD-10-CM/PCS Data. 2017. Retrieved 1 October 2021 at https://www.hcup-us.ahrq.gov/datainnovations/HCUP_RecomForReportingTrends_070517.pdf.
Mandelbaum AD, Thompson CK, Attai DJ, et al. National trends in immediate breast reconstruction: an analysis of implant-based versus autologous reconstruction after mastectomy. Ann Surg Oncol. 2020;27:4777–85.
National Cancer Institute STM. Types of Registries. Retrieved 1 October 2021 at https://training.seer.cancer.gov/registration/types/.
Bilimoria KY, Bentrem DJ, Stewart AK, Winchester DP, Ko CY. Comparison of commission on cancer-approved and -nonapproved hospitals in the United States: implications for studies that use the National Cancer Database. J Clin Oncol. 2009;27:4177–81.
Acknowledgement
This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748, which supports Memorial Sloan Kettering Cancer Center’s research infrastructure.
Author information
Authors and Affiliations
Corresponding authors
Ethics declarations
Disclosures
There are no conflicts of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Rubenstein, R.N., Nelson, J.A., Azoury, S.C. et al. Breast Surgical Oncology Epidemiologic Research: A Guide and Comparison of Four National Databases. Ann Surg Oncol 30, 2069–2084 (2023). https://doi.org/10.1245/s10434-022-12890-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-022-12890-6