Primary cesarean delivery risk continues to increase above age 35 regardless of prior vaginal birth, with the highest risk among women aged 50 years and older.
Background
Adjuvant endocrine therapy (AET) has been shown to reduce the risk of
second breast cancer events in women with ductal carcinoma in situ (DCIS).
There is no population-level evaluation of AET use in DCIS patients
subsequent to standardized reporting of estrogen receptor (ER) status in
cancer registries in 2004.
Methods
We conducted a retrospective cohort study of women with DCIS in the
National Cancer Database between 2005 and 2012. Patient, tumor and treatment
characteristics, and temporal trends associated with receipt of AET were
evaluated using generalized linear regression.
Results
Among 206,255 DCIS patients, 36.5% received AET. Fewer than
half of ER+ patients (n=62,146, 46.4%) received AET
with a modest but significant increase over time (43.6% in 2005 to
47.5% in 2012; unadjusted p-trend <0.001). AET decreased
among ER- patients (8.9% to 6.5%, p-trend<0.001). On
multivariate analysis, younger (<40 years) and older (≥70
years) women were less likely to receive AET than 50-59 year old women
(<40 years RR 0.86, 95% CI 0.82-0.89; ≥70 years, RR
0.79, 95% CI 0.77-0.81). ER+ status conferred a 6.15-fold
higher likelihood of receiving AET compared to ER- status (95% CI
5.81-6.50). Women who underwent breast-conserving surgery (BCS) with
adjuvant radiation were the most likely to receive AET.
Conclusions
Receipt of AET is relatively low in the group of women most likely to
benefit from its use, namely ER+ patients who underwent BCS.
Significant variation exists with respect to patient, tumor, site and
treatment factors. More tolerable drugs or clearer guideline recommendations
may increase use.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.