&lt;p&gt;Validation of an Algorithm to Ascertain Late Breast Cancer Recurrence Using Danish Medical Registries&lt;/p&gt;

Pedersen, Rikke Nørgaard; Öztürk, Buket Çalışkaner; Mellemkjær, Lene; Friis, Søren; Tramm, Trine; Nørgaard, Mette; Cronin-Fenton, Deirdre

doi:10.2147/clep.s269962

Cited by 14 publications

(15 citation statements)

References 35 publications

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“…The strengths of this study include the population-based design within a setting of universal tax-supported health care, large sample size, prospective data collection, and long-term and complete follow-up as well as the use of a custom-designed and validated algorithm ( 27 ). Yet, the positive predictive value of our late BCR algorithm was 86% (95% CI = 78% to 91%), so some of our late BCRs could be false positives.…”

Section: Discussionmentioning

confidence: 99%

“…Recurrences are routinely registered in the DBCG database up to 10 years after diagnosis. We therefore used a previously developed and validated algorithm ( 27 ) to capture patients who developed late BCR using Danish registries. The algorithm incorporated information on diagnostic, therapeutic, and procedural codes from the DNPR and cancer diagnoses from the DCR, DPR, and the database on CBC ( 27 ).…”

Section: Methodsmentioning

confidence: 99%

“…We therefore used a previously developed and validated algorithm ( 27 ) to capture patients who developed late BCR using Danish registries. The algorithm incorporated information on diagnostic, therapeutic, and procedural codes from the DNPR and cancer diagnoses from the DCR, DPR, and the database on CBC ( 27 ). Recurrences registered in the DBCG 10 years or more after primary surgery were included as a late recurrence.…”

Section: Methodsmentioning

confidence: 99%

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The Incidence of Breast Cancer Recurrence 10-32 Years After Primary Diagnosis

Pedersen

Esen

Mellemkjær

et al. 2021

JNCI: Journal of the National Cancer Institute

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174

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Background Extended, more effective breast cancer (BC) treatments have increased the prevalence of long term survivors. We investigated the risk of late breast cancer recurrence (BCR), 10 years or more after primary diagnosis, and associations between patient and tumor characteristics at primary diagnosis and late BCR up to 32 years after primary BC diagnosis. Methods Using the Danish Breast Cancer Group clinical database, we identified all women with an incident early BC diagnosed during 1987–2004. We restricted to women who survived 10 years without a recurrence or second cancer (10-year disease-free survivors) and followed them from 10 years after BC diagnosis date until late recurrence, death, emigration, second cancer or December 31, 2018. We calculated incidence rates per 1,000 person-years and cumulative incidences for late BCR, stratifying by patient- and tumor characteristics. Using Cox regression, we calculated adjusted hazard ratios for late BCR accounting for competing risks. Results Among 36,924 women with BC, 20,315 became 10-year disease-free survivors. Of these, 2,595 developed late BCR (incidence rate = 15.53 per 1,000 person-years, 95% confidence interval = 14.94–16.14; cumulative incidence = 16.6%, 95% confidence interval = 15.8%–17.5%) from year 10 to 32 after primary diagnosis. Tumor size larger than 20 mm, lymph node positive disease, and estrogen receptor-positive tumors were associated with increased cumulative incidences and hazards for late BCR. Conclusion Recurrences continued to occur up to 32 years after primary diagnosis. Women with high lymph node burden, large tumor size and ER-positive tumors had increased risk of late recurrence. Such patients may warrant extended surveillance, more aggressive treatment, or new therapy approaches.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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The Incidence of Breast Cancer Recurrence 10-32 Years After Primary Diagnosis

Pedersen

Esen

Mellemkjær

et al. 2021

JNCI: Journal of the National Cancer Institute

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174

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“…24 More information about the 10-year disease-free survivors and the identification of late BC recurrences are available in previous papers. 5,24 Registration of cancer treatments in the DNPR was first mandatory in 2001. 17 We restricted our study population to women who developed recurrent BC from January 1, 2004, and forward.…”

Section: Methodsmentioning

confidence: 99%

Mortality After Late Breast Cancer Recurrence in Denmark

Pedersen

Mellemkjær

Ejlertsen

et al. 2022

JCO

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PURPOSE Late breast cancer (BC) recurrence (ie, ≥ 10 years after primary diagnosis) may have a more favorable prognosis than earlier recurrence. We investigated the risk of BC death after late recurrence, identified prognostic factors, and compared survival after early and late recurrence. METHODS Using the Danish Breast Cancer Group and other nationwide databases, we identified women with early or late BC recurrence during 2004-2018, who were alive 6 months after recurrence. We followed them until BC death, death from other causes, emigration, 10 years, or December 31, 2018, whichever came first. We calculated mortality rates (MRs) per 1,000 person-years (PY) and cumulative BC mortality, for early versus late recurrence, and by characteristics of the primary tumor and the late recurrence. Using Cox regression, we calculated adjusted hazard ratios (HRs) for BC death, accounting for death from other causes as competing risks. RESULTS Among 2,004 patients with late recurrence, 721 died of BC with a median survival time of 10 years (MR = 84.8 per 1,000 PY; 10-year cumulative mortality = 50%). Among 1,528 patients with early recurrence, 1,092 BC deaths occurred with a median survival time of 4 years (MR = 173.9 per 1,000 PY; 10-year cumulative mortality = 72%). We observed a lower hazard of BC-specific death among patients who developed late compared with early recurrence (hazard ratio = 0.72; 95% CI, 0.62 to 0.85). Advanced stage at primary diagnosis, distant metastases, adjuvant treatment for locoregional recurrence, and systemic treatment for distant recurrence were associated with increased mortality after late recurrence. Breast-conserving surgery at primary diagnosis, locoregional recurrence, and surgery for recurrence were associated with lower mortality after late recurrence. CONCLUSION Patients with late recurrence had more favorable prognosis than patients with early recurrence. The localization of recurrent disease was the main prognostic factor for BC death.

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“…3 Internationally, algorithms based on routinely collected data like medical claims and cancer-related register data have been developed to identify patients diagnosed with cancer recurrence, mainly from breast and colorectal cancer; the validation of these algorithms has shown mixed results. [6][7][8][9][10][11][12] Recent studies have shown that cancer-specific algorithms based on Danish national health registries can accurately identify patients diagnosed with recurrence of colorectal cancer, 13 breast cancer, [14][15][16] bladder cancer, 17 or endometrial cancer, 18 with little selection bias. However, no similar approach exists to identify patients diagnosed with recurrence of malignant melanoma.…”

Section: Introductionmentioning

confidence: 99%

A Validated Register-Based Algorithm to Identify Patients Diagnosed with Recurrence of Malignant Melanoma in Denmark

Rasmussen¹,

Jensen²,

Virgilsen³

et al. 2021

CLEP

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Information on cancer recurrence is rarely available outside clinical trials. Wide exclusion criteria used in clinical trials tend to limit the generalizability of findings to the entire population of people living beyond a cancer disease. Therefore, population-level evidence is needed. The aim of this study was to develop and validate a register-based algorithm to identify patients diagnosed with recurrence after curative treatment of malignant melanoma. Patients and Methods: Indicators of recurrence were diagnosis and procedure codes recorded in the Danish National Patient Register and pathology results recorded in the Danish National Pathology Register. Medical records on recurrence status and recurrence date in the Danish Melanoma Database served as the gold standard to assess the accuracy of the algorithm. Results: The study included 1747 patients diagnosed with malignant melanoma; 95 (5.4%) were diagnosed with recurrence of malignant melanoma according to the gold standard. The algorithm reached a sensitivity of 93.7% (95% confidence interval (CI) 86.8-97.6), a specificity of 99.2% (95% CI: 98.6-99.5), a positive predictive value of 86.4% (95% CI: 78.2-92.4), and negative predictive value of 99.6% (95% CI: 99.2-99.9). Lin's concordance correlation coefficient was 0.992 (95% CI: 0.989-0.996) for the agreement between the recurrence dates generated by the algorithm and by the gold standard. Conclusion: The algorithm can be used to identify patients diagnosed with recurrence of malignant melanoma and to establish the timing of recurrence. This can generate populationlevel evidence on disease-free survival and diagnostic pathways for recurrence of malignant melanoma.

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<p>Validation of an Algorithm to Ascertain Late Breast Cancer Recurrence Using Danish Medical Registries</p>

Cited by 14 publications

References 35 publications

The Incidence of Breast Cancer Recurrence 10-32 Years After Primary Diagnosis

The Incidence of Breast Cancer Recurrence 10-32 Years After Primary Diagnosis

Mortality After Late Breast Cancer Recurrence in Denmark

A Validated Register-Based Algorithm to Identify Patients Diagnosed with Recurrence of Malignant Melanoma in Denmark

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