TY - JOUR
T1 - Incidence and outcome of breast biopsy procedures during follow-up after treatment for breast cancer
AU - van la Parra, Raquel F.D.
AU - Liao, Kaiping
AU - Smith, Benjamin D.
AU - Yang, Wei T.
AU - Leung, Jessica W.T.
AU - Giordano, Sharon H.
AU - Kuerer, Henry M.
N1 - Funding Information:
Funding/Support: This study was supported by a Clinical KWF Fellowship from the Dutch Cancer Society (Dr van la Parra), the PH and Fay Etta Robinson Distinguished Professorship in Cancer Research Endowment (Dr Kuerer), Cancer Center Support Grant CA16672 from the National Institutes of Health, the MD Anderson Clinical Research Funding Award Program (Dr Kuerer), the Andrew Sabin Family Fellowship (Dr Smith), grant RP 160674 from the Cancer Prevention and Research Institute of Texas (Dr Smith), and grant R01 CA207216-01 from the National Cancer Institute (Dr Smith).
Funding Information:
This study was supported by a Clinical KWF Fellowship from the Dutch Cancer Society (Dr van la Parra), the PH and Fay Etta Robinson Distinguished Professorship in Cancer Research Endowment (Dr Kuerer), Cancer Center Support Grant CA16672 from the National Institutes of Health, the MD Anderson Clinical Research Funding Award Program (Dr Kuerer), the Andrew Sabin Family Fellowship (Dr Smith), grant RP 160674 from the Cancer Prevention and Research Institute of Texas (Dr Smith), and grant R01 CA207216-01 from the National Cancer Institute (Dr Smith).
Funding Information:
receiving research funding from Varian Medical Systems. Dr Leung reports serving on the Scientific Advisory Board for Hologic, Inc. Dr Kuerer reports receiving publishing patents, royalties, and other intellectual property from the New England Journal of Medicine Group and McGraw-Hill Publishing, serving on the speaker’s bureau for Physicians’ Education Resource, LLC, and formerly receiving research funding from Genomic Health. No other disclosures were reported.
Publisher Copyright:
© 2018 American Medical Association. All rights reserved.
PY - 2018/6
Y1 - 2018/6
N2 - IMPORTANCE No comprehensive data are available regarding the frequency of breast biopsies performed during follow-up of treatment for invasive breast cancer. OBJECTIVE To determine how often patients treated for breast cancer require breast biopsies during follow-up. DESIGN, SETTING, AND PARTICIPANTS This nationwide population-based cohort study included 41 510 patients 64 years or younger in a commercial insurance database and 80 369 patients 66 years or older in the Surveillance, Epidemiology, and End Results (SEER)–Medicare database. Patients were diagnosed with incident invasive breast cancer (stages I-III) from January 1, 2000, through December 31, 2011. Diagnosis and procedural codes were used to identify biopsy rates during follow-up. Data were analyzed from March 3 through October 3, 2017. MAIN OUTCOMES AND MEASURES Cumulative incidence and adjusted risk of breast biopsy and subsequent breast cancer treatment were calculated using the Kaplan-Meier method and Cox proportional hazards regression. All statistical tests were 2 sided. RESULTS Among the 121 879 patients in the study population, 5- and 10-year overall incidences of breast biopsy were 14.7% and 23.4%, respectively, in the commercial insurance cohort and 11.8% and 14.9%, respectively, in the SEER-Medicare cohort. The 5-year estimated incidence of breast biopsy was higher among women treated with brachytherapy (24.0% in the commercial insurance and 25.0% in the SEER-Medicare cohorts) than among those treated with whole-breast irradiation (16.7% in the commercial insurance and 15.1% in the SEER-Medicare cohorts) and persisted after multivariate adjustment in the commercial insurance (hazard ratio [HR], 1.53; 95% CI, 1.38-1.70; P < .001) and SEER-Medicare (HR, 1.76; 95% CI, 1.63-1.91; P < .001) cohorts. Adjuvant chemotherapy use (HR, 1.31; 95% CI, 1.25-1.37; P < .001) and patient age (>85 vs 66-69 years; HR, 0.40; 95% CI, 0.36-0.44; P < .001) in the SEER-Medicare cohort and endocrine therapy in the commercial insurance (HR, 0.88; 95% CI, 0.82-0.93; P < .001) and SEER-Medicare (HR, 0.91; 95% CI, 0.85-0.97; P = .002) cohorts were independently associated with biopsy. After unilateral mastectomy, the estimated 5-year contralateral breast biopsy rates were 10.4% and 7.7% in the commercial insurance and SEER-Medicare cohorts, respectively. Of the patients with breast biopsy, 1239 of 4158 patients (29.8%) in the commercial insurance cohort and 2258 of 9747 patients (23.2%) in the SEER-Medicare cohort underwent subsequent cancer treatment. CONCLUSIONS AND RELEVANCE These data on the need for breast biopsies during follow-up and subsequent treatments from a large cohort of women with commercial insurance and Medicare can be used in the context of therapy-planning discussions and survivorship expectations for patients with breast cancer.
AB - IMPORTANCE No comprehensive data are available regarding the frequency of breast biopsies performed during follow-up of treatment for invasive breast cancer. OBJECTIVE To determine how often patients treated for breast cancer require breast biopsies during follow-up. DESIGN, SETTING, AND PARTICIPANTS This nationwide population-based cohort study included 41 510 patients 64 years or younger in a commercial insurance database and 80 369 patients 66 years or older in the Surveillance, Epidemiology, and End Results (SEER)–Medicare database. Patients were diagnosed with incident invasive breast cancer (stages I-III) from January 1, 2000, through December 31, 2011. Diagnosis and procedural codes were used to identify biopsy rates during follow-up. Data were analyzed from March 3 through October 3, 2017. MAIN OUTCOMES AND MEASURES Cumulative incidence and adjusted risk of breast biopsy and subsequent breast cancer treatment were calculated using the Kaplan-Meier method and Cox proportional hazards regression. All statistical tests were 2 sided. RESULTS Among the 121 879 patients in the study population, 5- and 10-year overall incidences of breast biopsy were 14.7% and 23.4%, respectively, in the commercial insurance cohort and 11.8% and 14.9%, respectively, in the SEER-Medicare cohort. The 5-year estimated incidence of breast biopsy was higher among women treated with brachytherapy (24.0% in the commercial insurance and 25.0% in the SEER-Medicare cohorts) than among those treated with whole-breast irradiation (16.7% in the commercial insurance and 15.1% in the SEER-Medicare cohorts) and persisted after multivariate adjustment in the commercial insurance (hazard ratio [HR], 1.53; 95% CI, 1.38-1.70; P < .001) and SEER-Medicare (HR, 1.76; 95% CI, 1.63-1.91; P < .001) cohorts. Adjuvant chemotherapy use (HR, 1.31; 95% CI, 1.25-1.37; P < .001) and patient age (>85 vs 66-69 years; HR, 0.40; 95% CI, 0.36-0.44; P < .001) in the SEER-Medicare cohort and endocrine therapy in the commercial insurance (HR, 0.88; 95% CI, 0.82-0.93; P < .001) and SEER-Medicare (HR, 0.91; 95% CI, 0.85-0.97; P = .002) cohorts were independently associated with biopsy. After unilateral mastectomy, the estimated 5-year contralateral breast biopsy rates were 10.4% and 7.7% in the commercial insurance and SEER-Medicare cohorts, respectively. Of the patients with breast biopsy, 1239 of 4158 patients (29.8%) in the commercial insurance cohort and 2258 of 9747 patients (23.2%) in the SEER-Medicare cohort underwent subsequent cancer treatment. CONCLUSIONS AND RELEVANCE These data on the need for breast biopsies during follow-up and subsequent treatments from a large cohort of women with commercial insurance and Medicare can be used in the context of therapy-planning discussions and survivorship expectations for patients with breast cancer.
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U2 - 10.1001/jamasurg.2017.5572
DO - 10.1001/jamasurg.2017.5572
M3 - Article
C2 - 29387884
AN - SCOPUS:85049208908
SN - 2168-6254
VL - 153
SP - 559
EP - 568
JO - JAMA Surgery
JF - JAMA Surgery
IS - 6
ER -