Skip to main content

Advertisement

SpringerLink
Log in

Breast cancer survival, survival disparities, and guideline-based treatment

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

Abstract

Purpose

The role of appropriate therapy in breast cancer survival and survival disparities by race/ethnicity has not been fully elucidated. We investigated whether lack of guideline-recommended therapy contributed to survival differences overall and among Hispanics relative to non-Hispanic white (NHW) women in a case-cohort study.

Methods

The study included a 15% random sample of female invasive breast cancer patients diagnosed from 1997 to 2009 in 6 New Mexico counties and all deaths due to breast cancer-related causes. Information was obtained from comprehensive medical chart reviews. National Comprehensive Cancer Network (NCCN®) guideline-recommended treatment was assessed among white women aged < 70 who were free of contraindications for recommended therapy, had stage I–III tumors, and survived ≥ 12 months. Hazard ratios (HRs) and 95% confidence intervals (CIs) for breast cancer death were estimated using Cox proportional hazards models.

Results

Included women represented 4635 patients and 449 breast cancer deaths. Women who did not receive radiotherapy (HR 2.3; 95% CI 1.2–4.4) or endocrine therapy (HR 2.0; 95% CI 1.0–4.0) as recommended by guidelines had an increased risk of breast cancer death, relative to those treated appropriately. Receipt of guideline-recommended therapy did not differ between Hispanic and NHW women for chemotherapy (84.2% vs. 81.3%, respectively), radiotherapy (89.2% vs. 91.1%), or endocrine therapy (89.2% vs. 85.8%), thus did not influence Hispanic survival disparities.

Conclusions

Lack of guideline-recommended radiotherapy or endocrine therapy contributed to survival as strongly as other established prognostic indicators. Hispanic survival disparities in this population do not appear to be attributable to treatment differences.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology. Breast Cancer. 1997–2009. Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology® for Guidelines 1997–2009. ©National Comprehensive Cancer Network, Inc 2010. All rights reserved. To view the most recent and complete version of the guideline. www.nccn.org

  2. National Cancer Institute (2015) Breast cancer treatment—for health professionals (PDQ®). https://www.cancer.gov/types/breast/hp/breast-treatment-pdq. Accessed 2 Dec 2015

  3. Coates AS, Winer EP, Goldhirsch A, Gelber RD, Gnant M, Piccart-Gebhart M, Thurlimann B, Senn HJ, Panel M (2015) Tailoring therapies-improving the management of early breast cancer: St Gallen International expert consensus on the primary therapy of early breast cancer 2015. Ann Oncol 26(8):1533–1546. https://doi.org/10.1093/annonc/mdv221

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  4. Wockel A, Wolters R, Wiegel T, Novopashenny I, Janni W, Kreienberg R, Wischnewsky M, Schwentner L, Group BS (2014) The impact of adjuvant radiotherapy on the survival of primary breast cancer patients: a retrospective multicenter cohort study of 8935 subjects. Ann Oncol 25(3):628–632. https://doi.org/10.1093/annonc/mdt584

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  5. Badakhshi H, Gruen A, Sehouli J, Budach V, Boehmer D (2013) The impact of patient compliance with adjuvant radiotherapy: a comprehensive cohort study. Cancer Med 2(5):712–717. https://doi.org/10.1002/cam4.114

    Article  PubMed  PubMed Central  Google Scholar 

  6. Hebert-Croteau N, Brisson J, Latreille J, Rivard M, Abdelaziz N, Martin G (2004) Compliance with consensus recommendations for systemic therapy is associated with improved survival of women with node-negative breast cancer. J Clin Oncol 22(18):3685–3693. https://doi.org/10.1200/JCO.2004.07.018

    Article  PubMed  Google Scholar 

  7. Bickell NA, Wang JJ, Oluwole S, Schrag D, Godfrey H, Hiotis K, Mendez J, Guth AA (2006) Missed opportunities: racial disparities in adjuvant breast cancer treatment. J Clin Oncol 24(9):1357–1362

    Article  PubMed  Google Scholar 

  8. Haggstrom DA, Quale C, Smith-Bindman R (2005) Differences in the quality of breast cancer care among vulnerable populations. Cancer 104(11):2347–2358

    Article  PubMed  Google Scholar 

  9. Freedman RA, Virgo KS, He Y, Pavluck AL, Winer EP, Ward EM, Keating NL (2011) The association of race/ethnicity, insurance status, and socioeconomic factors with breast cancer care. Cancer 117(1):180–189

    Article  PubMed  Google Scholar 

  10. Smith GL, Shih YC, Xu Y, Giordano SH, Smith BD, Perkins GH, Tereffe W, Woodward WA, Buchholz TA (2010) Racial disparities in the use of radiotherapy after breast-conserving surgery: a national medicare study. Cancer 116(3):734–741. https://doi.org/10.1002/cncr.24741

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ooi SL, Martinez ME, Li CI (2011) Disparities in breast cancer characteristics and outcomes by race/ethnicity. Breast Cancer Res Treat 127(3):729–738. https://doi.org/10.1007/s10549-010-1191-6

    Article  PubMed  Google Scholar 

  12. Li CI, Malone KE, Daling JR (2003) Differences in breast cancer stage, treatment, and survival by race and ethnicity. Arch Intern Med 163(1):49–56

    Article  PubMed  Google Scholar 

  13. Warner ET, Tamimi RM, Hughes ME, Ottesen RA, Wong YN, Edge SB, Theriault RL, Blayney DW, Niland JC, Winer EP, Weeks JC, Partridge AH (2015) Racial and ethnic differences in breast cancer survival: mediating Effect of tumor characteristics and sociodemographic and treatment factors. J Clin Oncol 33(20):2254–2261. https://doi.org/10.1200/JCO.2014.57.1349

    Article  PubMed  PubMed Central  Google Scholar 

  14. Bickell NA, LePar F, Wang JJ, Leventhal H (2007) Lost opportunities: physicians’ reasons and disparities in breast cancer treatment. J Clin Oncol 25(18):2516–2521

    Article  PubMed  Google Scholar 

  15. Bickell NA, Shastri K, Fei K, Oluwole S, Godfrey H, Hiotis K, Srinivasan A, Guth AA (2008) A tracking and feedback registry to reduce racial disparities in breast cancer care. J Natl Cancer Inst 100(23):1717–1723

    Article  PubMed  PubMed Central  Google Scholar 

  16. Bickell NA, Weidmann J, Fei K, Lin JJ, Leventhal H (2009) Underuse of breast cancer adjuvant treatment: patient knowledge, beliefs, and medical mistrust. J Clin Oncol 27(31):5160–5167

    Article  PubMed  PubMed Central  Google Scholar 

  17. Warren JL, Klabunde CN, Schrag D, Bach PB, Riley GF (2002) Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population. Med Care 40(8 Suppl):IV-3–IV-18

    Google Scholar 

  18. Noone AM, Lund JL, Mariotto A, Cronin K, McNeel T, Deapen D, Warren JL (2014) Comparison of SEER treatment data with medicare claims. Med Care. https://doi.org/10.1097/MLR.0000000000000073

    Article  Google Scholar 

  19. Jagsi R, Abrahamse P, Hawley ST, Graff JJ, Hamilton AS, Katz SJ (2012) Underascertainment of radiotherapy receipt in surveillance, epidemiology, and end results registry data. Cancer 118(2):333–341. https://doi.org/10.1002/cncr.26295

    Article  PubMed  Google Scholar 

  20. Walker GV, Giordano SH, Williams M, Jiang J, Niu J, MacKinnon J, Anderson P, Wohler B, Sinclair AH, Boscoe FP, Schymura MJ, Buchholz TA, Smith BD (2013) Muddy water? Variation in reporting receipt of breast cancer radiation therapy by population-based tumor registries. Int J Radiat Oncol Biol Phys 86(4):686–693. https://doi.org/10.1016/j.ijrobp.2013.03.016

    Article  PubMed  Google Scholar 

  21. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383

    Article  PubMed  CAS  Google Scholar 

  22. Klabunde CN, Legler JM, Warren JL, Baldwin LM, Schrag D (2007) A refined comorbidity measurement algorithm for claims-based studies of breast, prostate, colorectal, and lung cancer patients. Ann Epidemiol 17(8):584–590. https://doi.org/10.1016/j.annepidem.2007.03.011

    Article  PubMed  Google Scholar 

  23. Paik S, Shak S, Tang G, Kim C, Baker J, Cronin M, Baehner FL, Walker MG, Watson D, Park T, Hiller W, Fisher ER, Wickerham DL, Bryant J, Wolmark N (2004) A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer. N Engl J Med 351(27):2817–2826. https://doi.org/10.1056/NEJMoa041588

    Article  PubMed  CAS  Google Scholar 

  24. Barlow WE (1994) Robust variance estimation for the case-cohort design. Biometrics 50(4):1064–1072

    Article  PubMed  CAS  Google Scholar 

  25. Rothman KJ, Greenland S (1998) Measures of effect and measures of association. In: Rothman KJ, Greenland S (eds) Modern epidemiology. Lippincott Williams and Wilkins, Philadelphia, pp 55–56

    Google Scholar 

  26. Brotman DJ (2006) Mediators of the association between mortality risk and socioeconomic status. JAMA 296(7):763–764. https://doi.org/10.1001/jama.296.7.763-b (Author reply 764)

    Article  PubMed  CAS  Google Scholar 

  27. Xue X, Xie X, Gunter M, Rohan TE, Wassertheil-Smoller S, Ho GY, Cirillo D, Yu H, Strickler HD (2013) Testing the proportional hazards assumption in case-cohort analysis. BMC Med Res Methodol 13:88. https://doi.org/10.1186/1471-2288-13-88

    Article  PubMed  PubMed Central  Google Scholar 

  28. Wu X-C, Lund MJ, Kimmick GG, Richardson LC, Sabatino SA, Chen VW, Fleming ST, Morris CR, Huang B, Trentham-Dietz A, Lipscomb J (2012) Influence of race, insurance, socioeconomic status, and hospital type on receipt of guideline-concordant adjuvant systemic therapy for locoregional breast cancers. J Clin Oncol 30(2):142–150

    Article  PubMed  Google Scholar 

  29. Cuzick J, Dowsett M, Pineda S, Wale C, Salter J, Quinn E, Zabaglo L, Mallon E, Green AR, Ellis IO, Howell A, Buzdar AU, Forbes JF (2011) Prognostic value of a combined estrogen receptor, progesterone receptor, Ki-67, and human epidermal growth factor receptor 2 immunohistochemical score and comparison with the Genomic Health recurrence score in early breast cancer. J Clin Oncol 29(32):4273–4278. https://doi.org/10.1200/JCO.2010.31.2835

    Article  PubMed  Google Scholar 

  30. Sparano JA, Wang M, Zhao F, Stearns V, Martino S, Ligibel JA, Perez EA, Saphner T, Wolff AC, Sledge GW Jr, Wood WC, Davidson NE (2012) Race and hormone receptor-positive breast cancer outcomes in a randomized chemotherapy trial. J Natl Cancer Inst 104(5):406–414

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  31. Albain KS, Unger JM, Crowley JJ, Coltman CA Jr, Hershman DL (2009) Racial disparities in cancer survival among randomized clinical trials patients of the Southwest Oncology Group. J Natl Cancer Inst 101(14):984–992

    Article  PubMed  PubMed Central  Google Scholar 

  32. Silber JH, Rosenbaum PR, Clark AS, Giantonio BJ, Ross RN, Teng Y, Wang M, Niknam BA, Ludwig JM, Wang W, Even-Shoshan O, Fox KR (2013) Characteristics associated with differences in survival among black and white women with breast cancer. JAMA 310(4):389–397

    Article  PubMed  CAS  Google Scholar 

  33. Hershman DL, Unger JM, Barlow WE, Hutchins LF, Martino S, Osborne CK, Livingston RB, Albain KS (2009) Treatment quality and outcomes of African American versus white breast cancer patients: retrospective analysis of Southwest oncology studies S8814/S8897. J Clin Oncol 27(13):2157–2162

    Article  PubMed  PubMed Central  Google Scholar 

  34. Jatoi I, Becher H, Leake CR (2003) Widening disparity in survival between white and African-American patients with breast carcinoma treated in the U. S. Department of Defense Healthcare system. Cancer 98(5):894–899. https://doi.org/10.1002/cncr.11604

    Article  PubMed  Google Scholar 

  35. Rizzo JA, Sherman WE, Arciero CA (2015) Racial disparity in survival from early breast cancer in the department of defense healthcare system. J Surg Oncol 111(7):819–823. https://doi.org/10.1002/jso.23884

    Article  PubMed  Google Scholar 

  36. Silva A, Rauscher GH, Hoskins K, Rao R, Ferrans CE (2013) Assessing racial/ethnic disparities in chemotherapy treatment among breast cancer patients in context of changing treatment guidelines. Breast Cancer Res Treat 142(3):667–672. https://doi.org/10.1007/s10549-013-2759-8

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  37. Jagsi R, Abrahamse P, Morrow M, Hawley ST, Griggs JJ, Graff JJ, Hamilton AS, Katz SJ (2010) Patterns and correlates of adjuvant radiotherapy receipt after lumpectomy and after mastectomy for breast cancer. J Clin Oncol 28(14):2396–2403

    Article  PubMed  PubMed Central  Google Scholar 

  38. Centers for Disease Control, National Center for Health Statistics (2008) National Health Statistics Reports. State, Regional and National Estimates of Health Insurance coverage for people under 65 years of age. National Health Interview Survey. https://www.cdc.gov/nchs/data/nhsr/nhsr001.pdf

Download references

Acknowledgements

We would like to thank Ms. Kimberly Cooke, Mr. Nicolas Eldredge, Ms. Rebecca Sando, Ms. Chanel Jim, Mr. Francisco Martinez, Ms. Nancy Brito, and Ms. Georgia Hufnagel for their assistance in conducting this study.

Funding

This study was supported by Grants R01CA132877 and 2P30CA11810 from the National Cancer Institute (NCI) and NCI contract HSN26120130010I-Task Order HHSN26100005 to the Surveillance Epidemiology End Results (SEER) program.

Author information

Authors and Affiliations

  1. Internal Medicine Department, University of New Mexico School of Medicine, MSC 10 5550, 1 University of New Mexico, Albuquerque, NM, 87131-0001, USA

    Deirdre A. Hill, Charles Wiggins, Eric Prossnitz & Melanie Royce

  2. Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA

    Deirdre A. Hill, Charles Wiggins, Eric Prossnitz & Melanie Royce

  3. Department of Hematology/Oncology, Emory University School of Medicine, Atlanta, GA, USA

    Sarah Friend

  4. Department of Pathology, University of New Mexico, Albuquerque, NM, USA

    Lesley Lomo & Marc Barry

Authors
  1. Deirdre A. Hill
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sarah Friend
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lesley Lomo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Charles Wiggins
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marc Barry
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eric Prossnitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Melanie Royce
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Deirdre A. Hill.

Ethics declarations

Conflict of interest

The authors declare that they do not have any conflict of interest in connection with this manuscript.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hill, D.A., Friend, S., Lomo, L. et al. Breast cancer survival, survival disparities, and guideline-based treatment. Breast Cancer Res Treat 170, 405–414 (2018). https://doi.org/10.1007/s10549-018-4761-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-018-4761-7

Keywords

Search

Navigation