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

Mohammad Shoaib Abrahimi, Mark Elwood, Ross Lawrenson, Ian Campbell and Sandar Tin Tin
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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
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

IJERPH, 2021, vol. 18, issue 5, 1-13

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.

Keywords: breast conserving therapy; mastectomy; survival; associated factors (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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