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Associated Factors and Survival Outcomes for Breast Conserving Surgery versus Mastectomy among New Zealand Women with Early-Stage Breast Cancer

Author

Listed:
  • Mohammad Shoaib Abrahimi

    (Section of Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland 1142, New Zealand)

  • Mark Elwood

    (Section of Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland 1142, New Zealand)

  • Ross Lawrenson

    (Department of NIDEA (National Institute of Demographic and Economic Analysis), Waikato Medical Research Centre, The University of Waikato, Hamilton 3240, New Zealand
    Department of Strategy, Investment and Transformation, Waikato District Health Board, Hamilton 3204, New Zealand)

  • Ian Campbell

    (Breast and General Surgeon, Waikato Hospital, Hamilton 3204, New Zealand)

  • Sandar Tin Tin

    (Section of Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland 1142, New Zealand)

Abstract

This study aimed to investigate type of loco-regional treatment received, associated treatment factors and mortality outcomes in New Zealand women with early-stage breast cancer who were eligible for breast conserving surgery (BCS). This is a retrospective analysis of prospectively collected data from the Auckland and Waikato Breast Cancer Registers and involves 6972 women who were diagnosed with early-stage primary breast cancer (I-IIIa) between 1 January 2000 and 31 July 2015, were eligible for BCS and had received one of four loco-regional treatments: breast conserving surgery (BCS), BCS followed by radiotherapy (BCS + RT), mastectomy (MTX) or MTX followed by radiotherapy (MTX + RT), as their primary cancer treatment. About 66.1% of women received BCS + RT, 8.4% received BCS only, 21.6% received MTX alone and 3.9% received MTX + RT. Logistic regression analysis was used to identify demographic and clinical factors associated with the receipt of the BCS + RT (standard treatment). Differences in the uptake of BCS + RT were present across patient demographic and clinical factors. BCS + RT was less likely amongst patients who were older (75+ years old), were of Asian ethnicity, resided in impoverished areas or areas within the Auckland region and were treated in a public healthcare facility. Additionally, BCS + RT was less likely among patients diagnosed symptomatically, diagnosed during 2000–2004, had an unknown tumour grade, negative/unknown oestrogen and progesterone receptor status or tumour sizes ≥ 20 mm, ≤50 mm and had nodal involvement. Competing risk regression analysis was undertaken to estimate the breast cancer-specific mortality associated with each of the four loco-regional treatments received. Over a median follow-up of 8.8 years, women who received MTX alone had a higher risk of breast cancer-specific mortality (adjusted hazard ratio: 1.38, 95% confidence interval (CI): 1.05–1.82) compared to women who received BCS + RT. MTX + RT and BCS alone did not have any statistically different risk of mortality when compared to BCS + RT. Further inquiry is needed as to any advantages BCS + RT may have over MTX alternatives.

Suggested Citation

  • Mohammad Shoaib Abrahimi & Mark Elwood & Ross Lawrenson & Ian Campbell & Sandar Tin Tin, 2021. "Associated Factors and Survival Outcomes for Breast Conserving Surgery versus Mastectomy among New Zealand Women with Early-Stage Breast Cancer," IJERPH, MDPI, vol. 18(5), pages 1-13, March.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:5:p:2738-:d:512924
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    References listed on IDEAS

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    1. Morris, C.R. & Cohen, R. & Schlag, R. & Wright, W.E., 2000. "Increasing trends in the use of breast-conserving surgery in California," American Journal of Public Health, American Public Health Association, vol. 90(2), pages 281-284.
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    1. Jerome-D'Emilia, Bonnie & Begun, James W., 2005. "Diffusion of breast conserving surgery in medical communities," Social Science & Medicine, Elsevier, vol. 60(1), pages 143-151, January.

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