title: Trends in breast cancer treatment in Korea and impact of compliance with consensus recommendations on survival.
abstract: Although some studies suggest that conformity with consensus recommendations for breast cancer therapy is associated with increased survival, the data are not clear. We identified patients in four hospital-based breast cancer registries in Korea who had undergone primary curative surgery (stage 0-III) from 1993 through 2002 (n = 8,407). We collected demographic and clinical characteristics such as age, stage, treatment, and hormone receptor status. We gathered 1993-2004 mortality data by linkage to the National Statistical Office. During the follow-up period of 43,145 person-years (mean, 5.13 years), we identified 899 deceased cases. We used the standard Poisson regression model to estimate the hazard ratio (HR) for survival in relation to conformity with guidelines for chemo-, hormone, and locoregional therapy. Guideline compliance for systemic therapy increased from 24.0% in 1993 to 83.8% in 2002. Among mastectomy patients with <4 positive lymph nodes and tumors <5 cm, post-mastectomy radiotherapy was associated with poor survival (HR 2.07; 95% CI: 1.53-2.81). Tamoxifen use was associated with better survival among patients with hormone receptor-positive tumors (HR 0.57; 95% CI: 0.45-0.73) and with poorer survival among hormone receptor-negative patients who had affected nodes (HR 1.58; 95% CI: 1.01-2.44). Relative to conformity, non-conformity with both chemo- and hormone therapy guidelines was associated with a 76% higher risk of death. Compliance with consensus recommendations for chemo- and hormone therapy is significantly associated with better survival. Overuse of post-mastectomy radiotherapy and tamoxifen beyond the consensus recommendations may be harmful.
authors.affiliation: Quality of Cancer Care Branch, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea.
authors.forename: Young Ho
authors.initials: YH
authors.lastname: Yun
authors.forename: Sang Min
authors.initials: SM
authors.lastname: Park
authors.forename: Dong Young
authors.initials: DY
authors.lastname: Noh
authors.forename: Seok Jin
authors.initials: SJ
authors.lastname: Nam
authors.forename: Se Hyun
authors.initials: SH
authors.lastname: Ahn
authors.forename: Byeong Woo
authors.initials: BW
authors.lastname: Park
authors.forename: Eun Sook
authors.initials: ES
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003245:Consensus Statements as Topic; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008408:Mastectomy; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011379:Prognosis; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents