Abstract A51: Postsurgery survival improvement of breast cancer in a community hospital in New York City during the periods 1997–2004 vs. 2005–2010
Authors: Singh Awinder P. , Wang Hua , Surani Aleem , Villani Gina M. , Chung Marcia A. , Cai Dongsheng , Go Alan R. , Pappas Peter J. 
Published: June 2012

Background: For the past two decades, breast cancer survival has significantly improved. Surgical resection, combined with pre and/or post-operative radiotherapy, chemotherapy, and hormone therapy, is the primary therapy for breast cancer. Although overall breast cancer survival has improved, there is limited survival data from inner city patients treated at safety net community hospitals. The aim of this study is to assess post-surgery survival in a community hospital with a predominantly African American (AA) population

Methods: This is a retrospective analysis of prospectively collected data from The Brooklyn Hospital Center's cancer registry, from 1997 to 2010. Of the 1538 patients in the registry, 201 were excluded leaving 1337. Among the 1337 patients, 1055 are AA, 235 are white, and 57 are Asian (not included in the data analysis). The study is divided into two time periods 1997–2004 (Period A) and 2005–2010 (Period B). Statistical analyses were performed by SPSS and Epi info software. Kaplan–Meier survival probabilities are calculated and multivariate Cox proportional hazards models were applied to estimate hazard ratios (HR) with 95% confidence intervals.

Results: There is no significant difference in age between subjects in period A and period B; the average age at diagnosis is 61.04 (SD± 13.99) and 59.95 (SD± 13.80) for periods A and B respectively. Significant differences were observed in the percentage of patients with high grade differential and advanced pathologies in period A as compared to period B with the latter group exhibiting a high percentage of low grade differential and early pathology stages (p &lt;0.001). ER/PR status differed between the time periods; 46/401 (11%) were ER positive in period A versus 37/200 (19.0%) in period B (P =0.024). 50/255 (20%) were PR positive in period A versus 34/145 (11%) in period B (p&lt;0.001). 33.1% (period A) vs 31.4% (later period B) received Modified radical mastectomy (MRM) and 27.9% (period A) vs. 39.1% (period B) received lumpectomy. 21.6% of subjects have partial mastectomies during 1997–2004 periods vs. 0.8% of patients receiving this type of surgery in later periods. Kaplan Meier survival analysis: post-surgery survival probability significantly improved when comparing 1997–2004 vs 2005–2010 periods (Log-rank p&lt;0.001) with a 5 year survival probability of 75.37% in 1997–2004 period and 87.62% in 2005–2010 period. Cox regression hazard ratio is 2.1824. This post-surgery survival improvement is not associated with grade, site of tumor and chemotherapy but is associated with pathology stages and number of lymph nodes removed.

Over the time periods, surgical techniques have evolved enormously and have gone from radical excisions of breast, skin, pectoral muscle, and auxiliary lymph nodes to breast-conserving lumpectomy followed by sentinel lymph node biopsy. These improvements combined with early detection have made surgery more acceptable to our inner city population indicating that improved survival rates can be obtained in this difficult patient population.

Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A51.