Surgical Management of Breast Cancer in 2010–2011 SEER Registries by Hormone and HER2 Receptor Status

Abstract

Background Although locoregional recurrence is known to affect overall survival for operable breast cancer, the impact of receptor status on locoregional control is debated. Currently, hormone receptor (HR) and human epidermal growth factor receptor-2 (HER2) status are generally not considered relevant to surgical choice. This study examines recent population-level surgical trends with regard to receptor status. Methods We used the Surveillance, Epidemiology, and End Results (SEER) data to identify stage I–III female breast cancers diagnosed from 2010 to 2011. Patients were categorized by HR and HER2 receptor status. Univariate and multivariate logistic regressions were used to assess factors associated with undergoing mastectomy and the choice of contralateral prophylactic mastectomy (CPM). Results The overall mastectomy rate for the 87,504 women diagnosed in 2010–2011 was 43.4 %. On multivariate analysis, the odds of receiving mastectomy was greater for HER2-positive disease with either HR-negative or HR-positive status, than for women with HER2-negative/HR-positive disease (odds ratio 1.73 and 1. 31, respectively; all p values <0.001). Age, stage, marital status, race, and year of diagnosis also correlated with mastectomy. Triple-negative breast cancer (TNBC) was associated with CPM, while HER2 status was not. The mastectomy rate, which increased overall from 2006 to 2010, has continued to increase for stage III disease but has decreased for stage I disease. Mastectomy rates overall were lower in 2011 than 2010 (p = 0.012). Conclusions HER2-positive disease and TNBC were independent predictors of more extensive surgery in this large, recent, population-based cohort. Although mastectomy rates have continued to increase for stage III disease, mastectomy rates overall were lower in 2011 than in previous years.

A population-based comparison of treatment patterns, resource utilization, and costs by cancer stage for Ontario patients with hormone receptor-positive/HER2-negative breast cancer

“…Patients with stage I-III HR+/HER2− BC underwent lumpectomy or mastectomy at rates of 71% and 25%, respectively, which demonstrates support for breast-conserving surgery comparable to [25] or greater than [26][27][28][29] that reported in other cohorts. Unfortunately, because systemic therapies can be entered into the ALR database as single agents and/or combination regimens and may be entered differently with each administration, it was prohibitively difficult to discern which regimens were given and for what duration.…”

Breast cancer in young black women

“…Younger black women were found to have more‐advanced disease but were equally likely to be diagnosed with TN breast cancer as older black women in the present study. Overall, 24·0 per cent of women were diagnosed with TN breast cancer, higher than the national rate of 12 per cent. Numerous previous studies have demonstrated disproportionately higher rates of TN breast cancer in black women and in young women overall.…”

Routine Pre-Treatment MRI for Breast Cancer in a Single-Payer Medical Center: Effects on Surgical Choices, Timing and Outcomes

“…A recent report of NSQIP data from 2005-2011 showed a relative increase in mastectomy of 2.9% per year during that time 13 . Additionally, the SEER database showed the mastectomy rate in 2011 was 46% 14 , which is roughly the same as the mastectomy rate in the MRG. Meanwhile, our control group mastectomy rate of 17.9% was quite low compared to the national average at that time (roughly 40%) 13 .…”