Kaiser Permanente Washington Health Research Institute, 1730, Minor Ave, Seattle, WA, 98101, USA.
Department of Epidemiology, University of Washington, Seattle, WA, 98105, USA.
Cancer Causes Control. 2022 Sep;33(9):1145-1153. doi: 10.1007/s10552-022-01603-9. Epub 2022 Jul 7.
Accounting for endocrine therapy use for breast cancer treatment is important for studies of survivorship. We evaluated the accuracy of Surveillance, Epidemiology, and End Results (SEER) breast cancer endocrine therapy data compared with pharmacy dispensings from an integrated health system.
We included women with non-metastatic hormone receptor positive primary breast cancer diagnosed between 1995 and 2017 enrolled in Kaiser Permanente Washington, linking their data with SEER. We used pharmacy dispensings for endocrine therapy within one year following diagnosis as our reference standard. We calculated kappa (concordance), positive predictive value (PPV), and negative predictive values (NPV) overall and stratified by woman and tumor characteristics of interest.
Of 5,055 women, mean age at diagnosis was 62 years (interquartile range = 53-71); 53% had localized stage, 56% received lumpectomy with radiation, and 31% received chemotherapy. SEER data alone identified 67% of women as having received endocrine therapy; this increased to 75% with pharmacy dispensings. SEER's concordance with pharmacy dispensings was 0.68 (PPV = 91%; NPV = 76%). PPV did not vary by tumor or women characteristics; however, NPV declined with younger age at diagnosis (64% in < 45 years vs. 86% in 75+ years), increasing tumor stage (49% in regional stage vs. 91% in DCIS), and chemotherapy treatment (41% in those with chemotherapy vs. 83% in those without chemotherapy).
Pharmacy dispensings enable more complete endocrine therapy capture, particularly in women with more advanced tumors or who receive chemotherapy. We determined woman, tumor, and treatment characteristics that contribute to underascertainment of endocrine therapy use in tumor registries.
乳腺癌治疗中内分泌治疗的使用情况对于生存研究非常重要。我们评估了监测、流行病学和最终结果（SEER）乳腺癌内分泌治疗数据与综合卫生系统药房配药的准确性。
我们纳入了 1995 年至 2017 年间在 Kaiser Permanente Washington 诊断为非转移性激素受体阳性原发性乳腺癌的女性，将她们的数据与 SEER 进行了关联。我们使用诊断后一年内的内分泌治疗药房配药作为参考标准。我们计算了 Kappa（一致性）、阳性预测值（PPV）和阴性预测值（NPV），并根据女性和肿瘤特征进行了分层。
在 5055 名女性中，诊断时的平均年龄为 62 岁（四分位距 = 53-71）；53%为局限性疾病，56%接受了保乳手术加放疗，31%接受了化疗。仅 SEER 数据识别出 67%的女性接受了内分泌治疗；而通过药房配药则增加到 75%。SEER 与药房配药的一致性为 0.68（PPV = 91%；NPV = 76%）。PPV 不受肿瘤或女性特征的影响；然而，NPV 随着诊断时年龄的降低而降低（<45 岁时为 64%，75 岁及以上时为 86%），肿瘤分期升高（区域性疾病时为 49%，DCIS 时为 91%），以及化疗治疗（接受化疗的患者为 41%，未接受化疗的患者为 83%）。
药房配药可以更完整地捕获内分泌治疗，尤其是在肿瘤更晚期或接受化疗的女性中。我们确定了导致肿瘤登记处内分泌治疗使用情况未被充分确定的女性、肿瘤和治疗特征。
