title: Mortality impact of less-than-standard therapy in older breast cancer patients.
abstract: BACKGROUND
  The purpose of this study was to compare the rates of all-cause and breast cancer-specific mortality after breast-conserving surgery (BCS) only, BCS plus radiation therapy (RT), mastectomy, and the receipt of adjuvant tamoxifen in a large population-based cohort of older women with early-stage disease.
  
  
  METHODS
  This cohort study was conducted within six US integrated health-care delivery systems. Automated administrative databases, medical records, and tumor registries were used to identify women aged 65 years or older who received BCS or mastectomy to treat stage I or II breast cancer diagnosed from January 1, 1990, through December 31, 1994. We compared cause-specific 10-year mortality rates across treatment categories by fitting Cox proportional hazards models adjusted for demographics and tumor characteristics.
  
  
  RESULTS
  We identified 1,837 women having operations for stage I or II breast cancer. Compared with women receiving mastectomy, those receiving BCS without RT were twice as likely to die of breast cancer (adjusted hazards ratio [HR]=2.19, 95% confidence interval [CI], 1.51 to 3.18). Breast cancer mortality rates were similar between women receiving BCS plus RT and women receiving mastectomy (adjusted HR=1.08, 95% CI, 0.79 to 1.48). In the subset of 886 chemotherapy-naive women treated with tamoxifen, those treated with tamoxifen for less than 1 year had a substantially higher breast cancer mortality rate than those exposed 5 years or more (adjusted HR=6.26, 95% CI, 3.10 to 12.64).
  
  
  CONCLUSIONS
  Our findings indicate that older women receiving BCS alone have higher rates of breast cancer death than those receiving BCS + RT or mastectomy and that the survival benefit from tamoxifen increases with increasing duration of treatment.
authors.affiliation: Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Marianne Ulcickas
authors.initials: MU
authors.lastname: Yood
authors.forename: Cynthia
authors.initials: C
authors.lastname: Owusu
authors.forename: Diana S M
authors.initials: DS
authors.lastname: Buist
authors.forename: Ann M
authors.initials: AM
authors.lastname: Geiger
authors.forename: Terry S
authors.initials: TS
authors.lastname: Field
authors.forename: Soe Soe
authors.initials: SS
authors.lastname: Thwin
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Lash
authors.forename: Marianne N
authors.initials: MN
authors.lastname: Prout
authors.forename: Feifei
authors.initials: F
authors.lastname: Wei
authors.forename: Virginia P
authors.initials: VP
authors.lastname: Quinn
authors.forename: Floyd J
authors.initials: FJ
authors.lastname: Frost
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Silliman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy / Q000379:methods*; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant / Q000379:methods; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013629:Tamoxifen / Q000627:therapeutic use; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen