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Introduction National Comprehensive Cancer Network (NCCN) guidelines recommend wide excision without axillary staging to treat phyllodes tumors of the breast. Without prospective trials to guide management, NCCN also recommends consideration of radiation therapy (XRT). We describe current patterns of care for the multidisciplinary management of phyllodes tumors. Methods Using Surveillance, Epidemiology and End Results Program (SEER) data, we identified women diagnosed with phyllodes tumors between 2000 and 2012 who underwent surgical therapy. Trends in breast conserving surgery (BCS), nodal sampling and XRT were assessed using the Cochrane-Armitage test. Multivariable logistic regression was used to identify factors associated with treatment. Results Of 1,238 patients, 56.9% underwent BCS and 23.6% underwent nodal sampling (10.5% after BCS vs 40.9% after mastectomy). After surgery, 15.4% received adjuvant XRT (BCS, 12.9% and mastectomy, 18.8%). XRT utilization increased significantly over the study period (BCS, p=<0.0001; mastectomy, p=0.0003) while nodal sampling did not change significantly. Women were more likely to receive mastectomy if they were older or had larger tumors. Nodal sampling was also associated with older age, larger tumor size and receipt of mastectomy. Receipt of XRT was associated with later year of diagnosis, larger tumors and nodal assessment. Conclusion Over time, an increasing number of women received XRT after surgical management of phyllodes tumor, and one in four women underwent nodal sampling. While some of this practice can be attributed to concern about more advanced disease in the absence of strong data, there may be an educational gap regarding current guidelines and appropriate management.

Background Post-mastectomy reconstruction is a critical component of high-quality breast cancer care. Prior studies demonstrate socioeconomic disparity in receipt of reconstruction. Our objective was to evaluate trends in receipt of immediate reconstruction and examine socio-economic factors associated with reconstruction in a contemporary cohort. Methods Using the National Cancer Database, we identified women < 75 years of age with stage 0-1 breast cancer treated with mastectomy (n=297,121). Trends in immediate reconstruction rates (2004-2013) for the overall cohort and stratified by socioeconomic factors were examined using Join-point regression analysis. Annual percent change (APC) was calculated. We then restricted our sample to a contemporary cohort (2010-2013, n=145,577). Multivariable logistic regression identified socioeconomic factors associated with immediate reconstruction. Average adjusted predicted probabilities of receiving reconstruction were calculated. Results Immediate reconstruction rates increased from 27% to 48%. Although absolute rates of reconstruction for each stratification group increased, similar APC’s across strata led to persistent gaps in receipt of reconstruction. On multivariable logistic regression using our contemporary cohort, race, income, education, and insurance type were all strongly associated with immediate reconstruction. Patients with the lowest predicted probability of receiving reconstruction were patients with Medicaid who live in areas with the lowest rates of high school graduation (black 42.4 (40.5-44.3)%, white 45.7 (43.9-47.4)%). Conclusions Although reconstruction rates have increased dramatically over the past decade, lower rates persist for disadvantaged patients. Understanding how socioeconomic factors influence receipt of reconstruction and identifying modifiable factors are critical next steps towards identifying interventions to reduce disparities in breast cancer surgical care.

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