Determinants of Breast-Conserving Surgery and Survival
Creators: name: University Of California Office Of The President
Publisher: name: University of California Office of the President
publisherIdentifier: https://ror.org/00dmfq477
publisherIdentifierScheme: ROR
Year: 2024

description: Primary therapy for breast cancer in women with localized disease has changed substantially in recent years. Breast-conserving surgery (BCS) with radiation therapy is an equally effective alternative to mastectomy, and was recommended for most women with stage I or II breast cancer by the 1990 National Institutes of Health Consensus Conference. (For this study, stage I or II is defined as localized tumors without lymph node involvement, or tumors up to 5 cm in diameter, with or without extension to axillary lymph node nodes on the same side.) Nevertheless, fewer than 50% of women who are eligible receive BCS in California, even though mastectomies may have profound emotional consequences and do not improve survival rates in women with small tumors. The goal of this study is to determine the reasons for the apparent underutilization of BCS in California. A better understanding of this phenomenon may reduce the human and economic costs of breast cancer. In particular, the physical and psychological impact associated with unnecessary mastectomies represent a human cost that can be minimized by understanding which factors affect the choice of surgical treatment. 
 
 
 
 
 
 
 
 The objectives of the project are to: 1) determine statewide and regional trends of BCS utilization and radiation therapy, 2) determine the most significant predictors of choice of surgery for BCS-eligible women, and 3) compare the five-year survival experience of women receiving BCS and BCS-eligible women receiving mastectomies. Data from the California Cancer Registry (CCR), including all reported diagnoses of first primary breast cancer within the state from 1988 to 1995, will be used in the analysis. This study will be the first to address the issue of BCS utilization and survival on a statewide basis. The CCR operates the most complete cancer reporting system in California, and the CCR breast cancer database will be complemented and enhanced through linkages with several additional statewide files. These linkages will enable the analysis of a wide range of factors which may influence the choice of surgical treatment for primary breast cancer, including socioeconomic status, education, insurance coverage, and co-morbidities. These factors have not yet been evaluated together with information on clinical factors, treatment, characteristics of the patient, hospital, and county of residence as predictors of surgery received and subsequent survival. The database generated during this study will contain the most comprehensive population-based information on breast cancer in California. Given the large number of breast cancer cases in the state, the proposed study will have enough power to reach a statistically sound conclusion. In addition, the substantial variation in race/ethnicity in California allows for in-depth analysis of possible differences in patterns of care among minority women. 
 
 
 
 
 
 
 
 Understanding why BCS has been underutilized in California is an important step towards ensuring that women with breast cancer have an informed choice and receive optimal treatment.