Is mastectomy undertreatment for low-risk breast cancers eligible for breast-conserving therapy?

Sanjay P. Bagaria, Nabil Wasif, Bhupendra Rawal, Sarah A. McLaughlin, Armando E. Giuliano

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2705-2712
Number of pages8
JournalCancer
Volume121
Issue number16
DOIs
StatePublished - Aug 1 2015

Fingerprint

Mastectomy
Estrogen Receptors
Breast Neoplasms
Breast
Biomarkers
Confidence Intervals
Therapeutics
Neoplasms
Survival
Epidemiology
Multivariate Analysis
Databases
Mortality

Keywords

  • biological markers
  • breast cancer
  • mastectomy

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Is mastectomy undertreatment for low-risk breast cancers eligible for breast-conserving therapy? / Bagaria, Sanjay P.; Wasif, Nabil; Rawal, Bhupendra; McLaughlin, Sarah A.; Giuliano, Armando E.

In: Cancer, Vol. 121, No. 16, 01.08.2015, p. 2705-2712.

Research output: Contribution to journalArticle

Bagaria, SP, Wasif, N, Rawal, B, McLaughlin, SA & Giuliano, AE 2015, 'Is mastectomy undertreatment for low-risk breast cancers eligible for breast-conserving therapy?', Cancer, vol. 121, no. 16, pp. 2705-2712. https://doi.org/10.1002/cncr.29416
Bagaria, Sanjay P. ; Wasif, Nabil ; Rawal, Bhupendra ; McLaughlin, Sarah A. ; Giuliano, Armando E. / Is mastectomy undertreatment for low-risk breast cancers eligible for breast-conserving therapy?. In: Cancer. 2015 ; Vol. 121, No. 16. pp. 2705-2712.
@article{73f252a4ccf8425eb89221d3877b039f,
title = "Is mastectomy undertreatment for low-risk breast cancers eligible for breast-conserving therapy?",
abstract = "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.",
keywords = "biological markers, breast cancer, mastectomy",
author = "Bagaria, {Sanjay P.} and Nabil Wasif and Bhupendra Rawal and McLaughlin, {Sarah A.} and Giuliano, {Armando E.}",
year = "2015",
month = "8",
day = "1",
doi = "10.1002/cncr.29416",
language = "English (US)",
volume = "121",
pages = "2705--2712",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "16",

}

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.

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

VL - 121

SP - 2705

EP - 2712

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 16

ER -