LeMasters Traci J, Madhavan Suresh S, Sambamoorthi Usha, Vyas Ami M
Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University , Morgantown, West Virginia.
J Womens Health (Larchmt). 2017 Jul;26(7):735-744. doi: 10.1089/jwh.2015.5639. Epub 2017 Feb 7.
Although breast cancer is most prevalent among older women, the majority are diagnosed at an early stage. When diagnosed at an early stage, women have the option of breast-conserving surgery (BCS) plus radiation therapy (RT) or mastectomy for the treatment of early-stage breast cancer (ESBC). Omission of RT when receiving BCS increases the risk for recurrence and poor survival. Yet, a small subset of older women may omit RT after BCS. This study examines the current patterns of local treatment for ESBC among older women.
This study conducted a retrospective observational analysis using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked dataset of women age ≥66 diagnosed with stage I-II breast cancer in 2003-2009. SEER-Medicare data was additionally linked with data from the Area Resource File (ARF) to examine the association between area-level healthcare resources and treatment. Two logistic regression models were used to estimate how study factors were associated with receiving (1) BCS versus BCS+RT and (2) Mastectomy versus BCS+RT. A stratified analysis was also conducted among women aged <70 years.
Among 45,924 patients, 55% received BCS+RT, 23% received mastectomy, and 22% received BCS only. Women of increasing age, comorbidity, primary care provider visits, stage II disease, and nonwhite race were more likely to have mastectomy or BCS only, than BCS+RT. Women diagnosed in 2004-2006, treated by an oncology surgeon, residing in metro areas, areas of greater education and income, were less likely to receive mastectomy or BCS only, than BCS+RT. While women aged <70 years were more likely to receive BCS+RT, socioeconomic and physician specialties were associated with receiving BCS only.
Over half of older women with ESBC initially receive BCS+RT. The likelihood for mastectomy and BCS only increases with age, comorbidity, and vulnerable socio-demographic characteristics. Findings demonstrate continued treatment disparities among certain vulnerable populations.
尽管乳腺癌在老年女性中最为常见，但大多数患者在早期被诊断出来。早期诊断时，女性可以选择保乳手术（BCS）加放射治疗（RT）或乳房切除术来治疗早期乳腺癌（ESBC）。接受BCS时省略RT会增加复发风险和降低生存率。然而，一小部分老年女性在接受BCS后可能会省略RT。本研究调查了老年女性ESBC的当前局部治疗模式。
本研究使用2003 - 2009年诊断为I - II期乳腺癌的≥66岁女性的监测、流行病学和最终结果（SEER）-医疗保险关联数据集进行回顾性观察分析。SEER - 医疗保险数据还与地区资源文件（ARF）的数据相关联，以检查地区层面的医疗资源与治疗之间的关联。使用两个逻辑回归模型来估计研究因素与接受（1）BCS与BCS + RT以及（2）乳房切除术与BCS + RT之间的关联。还对年龄小于70岁的女性进行了分层分析。
在45924名患者中，55%接受了BCS + RT，23%接受了乳房切除术，22%仅接受了BCS。年龄增长、合并症、初级保健提供者就诊、II期疾病和非白人种族的女性比接受BCS + RT的女性更有可能接受乳房切除术或仅接受BCS。2004 - 2006年诊断、由肿瘤外科医生治疗、居住在大都市地区、教育程度和收入较高地区的女性比接受BCS + RT的女性更不可能接受乳房切除术或仅接受BCS。虽然年龄小于70岁的女性更有可能接受BCS + RT，但社会经济因素和医生专业与仅接受BCS有关。
超过一半的老年ESBC女性最初接受BCS + RT。乳房切除术和仅接受BCS的可能性随着年龄、合并症和脆弱的社会人口特征而增加。研究结果表明某些弱势群体之间存在持续的治疗差异。
