Abstract P3-07-11: Trends in clinicopathologic features and systemic therapy use in breast cancer patients: Findings from the National Cancer Database
Authors: Chagpar Anees B , Mougalian Sarah , Lannin Donald , Abu-Khalaf Maysa , Killelea Brigid , Sanft Tara , Pusztai Lajos 
Published: May 2015

Abstract
Introduction: Breast cancer remains the most common malignancy affecting women in the United States. We sought to identify temporal trends in the clinicopathologic features of breast cancer over the last 13 years, along with changes in systemic therapy usage to treat this disease.
Methods: The National Cancer Database is a national resource maintained by the CoC and the American Cancer Society that captures 70% of the newly diagnosed breast cancers in the US. We utilized the beta-PUF file of the NCDB, which included 1,669,679 patients with invasive breast cancer patients from 1998 to 2010, and analyzed trends in clinicopathologic features as well as use of systemic chemo- and hormonal therapy.
Results: Over the 13 years of the study, a significant trend was noted to older age, lower grade and fewer positive lymph nodes (all p&lt;0.001). Yet, the proportion of patients receiving systemic chemotherapy and hormonal therapy also increased over this time period (p&lt;0.001). These trends remained when the time period was bisected into an early (prior to 2004) and later (after 2004) time period (shown in the table below). Receipt of systemic therapy was positively correlated with younger age, larger tumor size, higher grade and more positive lymph nodes over this time period (all p&lt;0.001). There was a small increase in tumor size (&lt;0.1 mm) in the latter period, but other factors were more favorable. Nonetheless, there has been a significantly higher utilization of systemic chemotherapy (OR: 1.107; 95% CI: 1.017-1.098, p&lt;0.001) and hormonal therapy (OR: 1.588; 95% CI: 1.578-1.598, p&lt;0.001) in more recent years, even when controlling for changes in clinicopathologic features on multivariate analysis.
Prior to 2004After 2004p-valueMean age at diagnosis (years)60.160.3&lt;0.001Mean tumor size (mm)20.120.2&lt;0.001Mean number of positive nodes1.31.2&lt;0.001Proportion grade 3 (%)36.834.6&lt;0.001Proportion receiving chemotherapy (%)41.142.2&lt;0.001Proportion receiving hormonal therapy (%)41.753.5&lt;0.001
Conclusions: These data demonstrate that while early detection may be increasing the number of low grade node-negative tumors in older patients, our use of systemic therapy has become more liberal. Increasing use of hormonal therapy may be due to more aggressive guidelines and a lower threshold for ER-positivity; increasing use of chemotherapy may be the result of more efficacious drugs with lower toxicity being available to treat limited disease. Nonetheless, implications in terms of cost vs. benefit of our more aggressive approach may warrant further evaluation.
Citation Format: Anees B Chagpar, Sarah Mougalian, Donald Lannin, Maysa Abu-Khalaf, Brigid Killelea, Tara Sanft, Lajos Pusztai. Trends in clinicopathologic features and systemic therapy use in breast cancer patients: Findings from the National Cancer Database [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-07-11.