TY - JOUR
T1 - Is mastectomy undertreatment for low-risk breast cancers eligible for breast-conserving therapy?
AU - Bagaria, Sanjay P.
AU - Wasif, Nabil
AU - Rawal, Bhupendra
AU - McLaughlin, Sarah A.
AU - Giuliano, Armando E.
N1 - Publisher Copyright:
© 2015 American Cancer Society Patients with estrogen receptor-positive, low-grade breast cancers appear to have a survival disadvantage when they are treated with mastectomy versus breast-conserving therapy. Biomarker profiles may help to optimize the choice of local therapy. © 2015 American Cancer Society.
PY - 2015/8/1
Y1 - 2015/8/1
N2 - BACKGROUND Biomarkers are routinely used to predict responses to systemic therapies, but their utility for predicting responses to local therapy for breast cancer is not known. This study determined whether biomarkers could predict responses to breast-conserving therapy (BCT) and mastectomy. METHODS A review of the Surveillance, Epidemiology, and End Results database identified women diagnosed with early-stage invasive ductal breast cancer and treated with BCT or mastectomy from 1998 to 2008. The estrogen receptor (ER) status and the histologic grade were used to construct 3 biomarker profiles: low risk (ER-positive, low/intermediate grade), intermediate risk (ER-positive, high grade), and high risk (ER-negative, any grade). The primary measured outcome was disease-specific survival (DSS). RESULTS BCT and mastectomy were performed in 114,486 patients (59.2%) and 79,035 patients (40.8%), respectively. There were 122,420 low-risk patients (63.3%), 34,341 intermediate-risk patients (17.7%), and 36,760 high-risk patients (19.0%). Multivariate analyses were performed separately for patients with low-, intermediate-, and high-risk tumors. The adjusted hazard ratios for DSS for patients who underwent mastectomy versus BCT for low-, intermediate-, and high-risk tumors were 1.66 (95% confidence interval [CI], 1.54-1.79; P<.001), 1.40 (95% CI, 1.29-1.53; P<.001), and 1.27 (95% CI, 1.19-1.35; P<.001), respectively. CONCLUSIONS Patients with ER-positive, low-grade breast cancers who underwent mastectomy had a 66% increase in disease-specific mortality versus those who underwent BCT. Biomarker profiles defined by the ER status and grade may improve the selection of local therapy for breast cancer. Cancer 2015;121:2705-2712.
AB - BACKGROUND Biomarkers are routinely used to predict responses to systemic therapies, but their utility for predicting responses to local therapy for breast cancer is not known. This study determined whether biomarkers could predict responses to breast-conserving therapy (BCT) and mastectomy. METHODS A review of the Surveillance, Epidemiology, and End Results database identified women diagnosed with early-stage invasive ductal breast cancer and treated with BCT or mastectomy from 1998 to 2008. The estrogen receptor (ER) status and the histologic grade were used to construct 3 biomarker profiles: low risk (ER-positive, low/intermediate grade), intermediate risk (ER-positive, high grade), and high risk (ER-negative, any grade). The primary measured outcome was disease-specific survival (DSS). RESULTS BCT and mastectomy were performed in 114,486 patients (59.2%) and 79,035 patients (40.8%), respectively. There were 122,420 low-risk patients (63.3%), 34,341 intermediate-risk patients (17.7%), and 36,760 high-risk patients (19.0%). Multivariate analyses were performed separately for patients with low-, intermediate-, and high-risk tumors. The adjusted hazard ratios for DSS for patients who underwent mastectomy versus BCT for low-, intermediate-, and high-risk tumors were 1.66 (95% confidence interval [CI], 1.54-1.79; P<.001), 1.40 (95% CI, 1.29-1.53; P<.001), and 1.27 (95% CI, 1.19-1.35; P<.001), respectively. CONCLUSIONS Patients with ER-positive, low-grade breast cancers who underwent mastectomy had a 66% increase in disease-specific mortality versus those who underwent BCT. Biomarker profiles defined by the ER status and grade may improve the selection of local therapy for breast cancer. Cancer 2015;121:2705-2712.
KW - biological markers
KW - breast cancer
KW - mastectomy
UR - http://www.scopus.com/inward/record.url?scp=84938748510&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84938748510&partnerID=8YFLogxK
U2 - 10.1002/cncr.29416
DO - 10.1002/cncr.29416
M3 - Article
C2 - 25920382
AN - SCOPUS:84938748510
SN - 0008-543X
VL - 121
SP - 2705
EP - 2712
JO - Cancer
JF - Cancer
IS - 16
ER -