title: A population-based study on the patterns of use of different chemotherapy regimens in Swiss patients with early breast cancer.
abstract: BACKGROUND
  There is considerable heterogeneity in the use of chemotherapy in early breast cancer (BC), despite international recommendations issued from the NCCN, NIH and the St.Gallen bi-annual conference.
  
  
  METHODS
  We included 1,535 patients from seven Swiss cancer registries between 2003 and 2005 receiving chemotherapy for stage I to III BC. Chemotherapy was categorised into (a) FAC/FEC, anthracyclines followed by CMF or anthracycline-taxane combinations (FAC-T) (781 patients) and (b) other chemotherapy regimens such as CMF/AC (EC) (754 patients). Predictors for choosing FAC-T over non-FAC-T chemotherapy were separately determined in all patients and in ER-negative patients (n = 496) by multivariate logistic regression analysis.
  
  
  RESULTS
  The use of FAC-T increased significantly over time, from 44% in 2003 to 55% in 2005. BC stage III (versus stage I-II) and nodal positivity were the predominant predictors for using FAC-T chemotherapy in the adjusted model (odds ratio (OR) 4.1, 95%-confidence intervals (CI) 2.6-6.3 and OR 3.0, 95%-CI 2.0-4.4, respectively). In high-risk ER-negative BC patients, poor histological differentiation was more important to choose FAC-T chemotherapy (OR 3.8, 95%-CI 1.9-7.5) than tumour stage or nodal status. The use of FAC-T chemotherapy varied substantially among the seven geographic regions, from 20% in rural Grisons-Glarus to 73% in Zurich.
  
  
  CONCLUSIONS
  Tumour biology is a predominant factor for choosing FAC-T over older chemotherapy regimens in patients with ER-negative early BC, but improvements should be made to reduce the substantial regional heterogeneity. Further epidemiological studies should assess how the use of FAC-T chemotherapy is affecting clinical outcome in patients with early BC and different risk profiles.
authors.affiliation: Cantonal Hospital, St. Gallen, Switzerland. markus.joerger@kssg.ch
authors.forename: Markus
authors.initials: M
authors.lastname: Joerger
authors.forename: Silvia
authors.initials: S
authors.lastname: Ess
authors.forename: Silvia
authors.initials: S
authors.lastname: Dehler
authors.forename: Anita
authors.initials: A
authors.lastname: Savidan
authors.forename: Christine
authors.initials: C
authors.lastname: Bouchardy
authors.forename: Harald
authors.initials: H
authors.lastname: Frick
authors.forename: Isabelle
authors.initials: I
authors.lastname: Konzelmann
authors.forename: Beat
authors.initials: B
authors.lastname: Thürlimann
mesh_terms: D018943:Anthracyclines / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology*; D001952:Bridged-Ring Compounds / Q000008:administration & dosage; D000069287:Capecitabine; D016190:Carboplatin / Q000008:administration & dosage; D016001:Confidence Intervals; D003520:Cyclophosphamide / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D004317:Doxorubicin / Q000008:administration & dosage; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008207:Lymphatic Metastasis; D055118:Medication Adherence; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016017:Odds Ratio; D017239:Paclitaxel / Q000008:administration & dosage; D011960:Receptors, Estrogen / Q000378:metabolism*; D013557:Switzerland; D043823:Taxoids / Q000008:administration & dosage; D014747:Vinblastine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000077235:Vinorelbine; D000093542:Gemcitabine
chemical_list: D018943:Anthracyclines; D001952:Bridged-Ring Compounds; D011960:Receptors, Estrogen; D043823:Taxoids; D003841:Deoxycytidine; C080625:taxane; D015251:Epirubicin; D014747:Vinblastine; D000069287:Capecitabine; D004317:Doxorubicin; D003520:Cyclophosphamide; D016190:Carboplatin; D017239:Paclitaxel; D000077235:Vinorelbine; D005472:Fluorouracil; D008727:Methotrexate; D000093542:Gemcitabine