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The Association Between Surgical Axillary Staging, Adjuvant Treatment Use and Survival in Older Women with Early Stage Breast Cancer: A Population-Based Study

  • Global Health Services Research
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Choosing Wisely guidelines recommend against surgical axillary staging (AS) in women ≥70 years with ER+/HER2– early stage breast cancer (BC). This study examined the impact of AS omission on survival in older patients with BC.

Methods

This was a population-based cohort study using health administrative data in Ontario, Canada. We identified women aged 65–95 years who underwent surgery for Stage I/II BC between 2010 and 2016. Patients were weighted by propensity scores for receipt of AS that included patient and disease characteristics using overlap weights. Association with overall survival (OS) was calculated using weighted Cox models, and breast cancer-specific survival (BCSS) was calculated using weighted Fine and Gray models, adjusting for biomarkers and adjuvant treatments. Adjuvant treatment receipt was modelled with weighted log-binomial models.

Results

Among 17,370 older women, the 1771 (10.2%) who did not undergo AS were older, more comorbid, and less likely to undergo mastectomy. Women who did not undergo AS were less likely to receive adjuvant chemotherapy (RR 0.68, 95% CI 0.57–0.82), endocrine therapy (RR 0.85, 95% CI 0.81–0.89) or radiotherapy (RR 0.69, 95% CI 0.65–0.74). After weighting and adjustment, there was no significant difference in BCSS (sdHR 0.98, 95% CI 0.77–1.25), but women who did not undergo AS had worse OS (HR 1.14, 95% CI 1.04–1.25). The results among 6215 ER+/HER2– women ≥70 years undergoing SLNB vs no AS were similar.

Conclusions

The omission of AS in older women with early stage BC was not associated with adverse BCSS, although OS was worse.

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Acknowledgement

This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). This document used data adapted from the Statistics Canada Postal Code OM Conversion File, which is based on data licensed from Canada Post Corporation, and/or data adapted from the Ontario Ministry of Health Postal Code Conversion File, which contains data copied under license from ©Canada Post Corporation and Statistics Canada. Parts of this material are based on data and/or information compiled and provided by: MOH, CIHI. The analyses, conclusions, opinions, and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred. Parts of this material are based on data and information compiled and provided by the Ontario Ministry of Health, Ontario Health (OH), and CIHI. We thank IQVIA Solutions Canada Inc. for use of their Drug Information File. Parts of this report are based on Ontario Registrar General (ORG) information on deaths, the original source of which is ServiceOntario. The views expressed therein are those of the author and do not necessarily reflect those of ORG or the Ministry of Public and Business Service Delivery.

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Authors and Affiliations

  1. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Matthew Castelo MD

  2. Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Matthew Castelo MD, Rinku Sutradhar MSc, PhD & Lawrence Paszat MD, MS

  3. ICES, Toronto, ON, Canada

    Rinku Sutradhar MSc, PhD, Neil Faught BSc, MSc, Lena Nguyen BSc, MSc, Lawrence Paszat MD, MS, Cindy Fong BSc, CCRP & Eileen Rakovitch MD, MSc

  4. Department of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada

    Danilo Giffoni M. M. Mata MD

  5. Department of Medicine, London Health Sciences Center, London, ON, Canada

    Danilo Giffoni M. M. Mata MD

  6. Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Lawrence Paszat MD, MS, Sabina Trebinjac BSc & Eileen Rakovitch MD, MSc

  7. Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada

    Ezra Hahn MD, Lawrence Paszat MD, MS, Danielle Rodin MD, MPH & Eileen Rakovitch MD, MSc

  8. Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada

    Ezra Hahn MD & Danielle Rodin MD, MPH

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  1. Matthew Castelo MD
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  2. Rinku Sutradhar MSc, PhD
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  7. Lawrence Paszat MD, MS
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  11. Eileen Rakovitch MD, MSc
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Correspondence to Eileen Rakovitch MD, MSc.

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Castelo, M., Sutradhar, R., Faught, N. et al. The Association Between Surgical Axillary Staging, Adjuvant Treatment Use and Survival in Older Women with Early Stage Breast Cancer: A Population-Based Study. Ann Surg Oncol 30, 3901–3912 (2023). https://doi.org/10.1245/s10434-023-13274-0

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