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Implications of missing data on reported breast cancer mortality

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Background

National cancer registries are valuable tools to analyze patterns of care and clinical outcomes; yet, missing data may impact the accuracy and generalizability of these data. We sought to evaluate the association between missing data and overall survival (OS).

Methods

Using the NCDB (National Cancer Database) and SEER (Surveillance, Epidemiology, End Results Program), we assessed data missingness among patients diagnosed with invasive breast cancer from 2010 to 2014. Key variables included demographic (age, race, ethnicity, insurance, education, income), tumor (grade, ER, PR, HER2, TNM stages), and treatment (surgery in both databases; chemotherapy and radiation in NCDB). OS was compared between those with and without missing data using Cox proportional hazards models.

Results

Overall, 775,996 patients in the NCDB and 263,016 in SEER were identified; missing at least 1 key variable occurred for 29% and 13%, respectively. Of those, the overwhelming majority (NCDB 80%; SEER 88%) were missing tumor variables. When compared to patients with complete data, missingness was associated with a greater risk of death: NCDB HR 1.23 (99% CI 1.21–1.25) and SEER HR 2.11 (99% CI 2.05–2.18). Patients with complete tumor data had higher unadjusted OS estimates than that of the entire sample: NCDB 82.7% vs 81.8% and SEER 83.5% vs 81.7% for 5-year OS.

Conclusions

Missingness of select variables is not uncommon within large national cancer registries and is associated with a worse OS. Exclusion of patients with missing variables may introduce unintended bias into analyses and result in findings that underestimate breast cancer mortality.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The National Cancer Data Base (NCDB) is a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society. The CoC's NCDB and the hospitals participating in the CoC NCDB are the source of the de-identified data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Funding

This work was in part supported by Duke Cancer Institute through NIH grant P30CA014236 (PI: Kastan) for the Biostatistics Core.

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Authors and Affiliations

  1. Department of Surgery, Duke University Medical Center, Durham, NC, DUMC 351327710, USA

    Jennifer K. Plichta, Holly C. Lewis, Marguerite M. Rooney, Dan G. Blazer, E. Shelley Hwang & Rachel A. Greenup

  2. Department of Population Health Sciences, Duke University Medical Center, Durham, NC, DUMC 351327710, USA

    Jennifer K. Plichta & Rachel A. Greenup

  3. Duke Cancer Institute, Durham, NC, USA

    Jennifer K. Plichta, Christel N. Rushing, Dan G. Blazer, Samantha M. Thomas, E. Shelley Hwang & Rachel A. Greenup

  4. Biostatistics Shared Resource, Duke Cancer Institute, Durham, NC, USA

    Christel N. Rushing & Samantha M. Thomas

  5. Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, USA

    Samantha M. Thomas

Authors
  1. Jennifer K. Plichta
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Contributions

Jennifer K. Plichta: conceptualization, methodology, data analysis, writing (original draft, review, and editing), project administration. Christel N. Rushing: methodology, resources, data curation, formal analysis, writing (review and editing). Holly C. Lewis: data review, writing (original draft, review, and editing). Marguerite M. Rooney: data review, writing (original draft, review, and editing). Dan G. Blazer: data analysis, writing (review, and editing). Samantha Thomas: data analysis, writing (review, and editing). E. Shelley Hwang: data analysis, writing (review, and editing). Rachel A. Greenup: conceptualization, methodology, resources, data analysis, writing (review, and editing), project administration.

Corresponding author

Correspondence to Jennifer K. Plichta.

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Conflict of interest

The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article. The authors have no relevant financial or non-financial interests to disclose. Dr. J. Plichta is a recipient of research funding by the Color Foundation (PI: Plichta). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Plichta, J.K., Rushing, C.N., Lewis, H.C. et al. Implications of missing data on reported breast cancer mortality. Breast Cancer Res Treat 197, 177–187 (2023). https://doi.org/10.1007/s10549-022-06764-4

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