title: Utilization of neoadjuvant chemotherapy varies in the treatment of women with invasive breast cancer.
abstract: BACKGROUND
  Treatment with neoadjuvant chemotherapy (NAC) has made it possible for some women to be successfully treated with breast conservation therapy (BCT ) who were initially considered ineligible. Factors related to current practice patterns of NAC use are important to understand particularly as the surgical treatment of invasive breast cancer has changed. The goal of this study was to determine variations in neoadjuvant chemotherapy use in a large multi-center national database of patients with breast cancer.
  
  
  METHODS
  We evaluated NAC use in patients with initially operable invasive breast cancer and potential impact on breast conservation rates. Records of 2871 women ages 18-years and older diagnosed with 2907 invasive breast cancers from January 2003 to December 2008 at four institutions across the United States were examined using the Breast Cancer Surgical Outcomes (BRCASO) database. Main outcome measures included NAC use and association with pre-operatively identified clinical factors, surgical approach (partial mastectomy [PM] or total mastectomy [TM]), and BCT failure (initial PM followed by subsequent TM).
  
  
  RESULTS
  Overall, NAC utilization was 3.8%l. Factors associated with NAC use included younger age, pre-operatively known positive nodal status, and increasing clinical tumor size. NAC use and BCT failure rates increased with clinical tumor size, and there was significant variation in NAC use across institutions. Initial TM frequency approached initial PM frequency for tumors >30-40 mm; BCT failure rate was 22.7% for tumors >40 mm. Only 2.7% of patients undergoing initial PM and 7.2% undergoing initial TM received NAC.
  
  
  CONCLUSIONS
  NAC use in this study was infrequent and varied among institutions. Infrequent NAC use in patients suggests that NAC may be underutilized in eligible patients desiring breast conservation.
authors.affiliation: Department of Hematology and Oncology, Marshfield Clinic, Weston, Wisconsin, USA and Clinical Epidemiology Unit, School of Population Health, University of Queensland, Brisbane, Australia.
authors.forename: Adedayo A
authors.initials: AA
authors.lastname: Onitilo
authors.affiliation: Grand Rapids Medical Education Partners, Grand Rapids, Michigan, USA.
authors.forename: Jill K
authors.initials: JK
authors.lastname: Onesti
authors.affiliation: University of Vermont, Burlington, Vermont, United States of America.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Single
authors.affiliation: Marshfield Clinic Cancer Care at St Michaels Hospital, Stevens Point, Wisconsin, United States of America.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Engel
authors.affiliation: University of Vermont College of Medicine, Burlington, Vermont, United States of America.
authors.forename: Ted A
authors.initials: TA
authors.lastname: James
authors.affiliation: Group Health Research Institute, Seattle, Washington, United States of America.
authors.forename: Erin J
authors.initials: EJ
authors.lastname: Aiello Bowles
authors.affiliation: Kaiser Permanente Colorado, Denver, Colorado, United States of America.
authors.forename: Heather
authors.initials: H
authors.lastname: Spencer Feigelson
authors.affiliation: Van Andel Research Institute, Grand Rapids, Michigan, United States of America.
authors.forename: Tom
authors.initials: T
authors.lastname: Barney
authors.affiliation: Van Andel Research Institute, Grand Rapids, Michigan, United States of America.
authors.forename: Laurence E
authors.initials: LE
authors.lastname: McCahill
mesh_terms: D000328:Adult; D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy / Q000379:methods*; D016896:Treatment Outcome