title: Use of neoadjuvant chemotherapy for patients with stage I to III breast cancer in the United States.
abstract: BACKGROUND
  Neoadjuvant chemotherapy (NAC) is the standard of care for patients with locally advanced breast cancer and can yield clinical advantages in individuals with lower stage cancers as well. To the authors' knowledge, the extent and patterns of use of NAC remain unknown. The objective of the current study was to assess temporal trends in NAC use and to examine what clinical, demographic, and treatment site characteristics influence its use.
  
  
  METHODS
  Data from the National Cancer Data Base regarding 395,486 patients with stage I to stage III breast cancer who received adjuvant or neoadjuvant chemotherapy in the United States from 2003 through 2011 were analyzed. Chi-square tests and logistic regression analyses were used to assess the association between NAC use and patient, tumor, and facility characteristics.
  
  
  RESULTS
  Overall, 17.4% of patients received NAC, including 4% of patients with stage I disease, 17.8% of patients with stage II disease, and 41.6% of patients with stage III disease. NAC use increased over time from 12.2% to 24.0%, particularly among patients with more advanced cancers. Rates increased from 12.9% to 39.3% in patients with stage IIIA, from 72.3% to 86.4% in patients with stage IIIB, and from 30.1% to 59.3% in patients with stage IIIC cancers. On multivariate analysis, patients aged <60 years, African American individuals, and those treated in academic centers were more likely to receive NAC. NAC use also varied by geographic region and was the highest in the West South Central region (21%) and lowest in the Midwest (15.2%).
  
  
  CONCLUSIONS
  Although NAC use increased between 2003 and 2011, <50% of all patients with stage III breast cancer were treated with NAC. Substantial regional and practice-related variations exist.
authors.affiliation: Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Sarah S
authors.initials: SS
authors.lastname: Mougalian
authors.affiliation: Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Pamela R
authors.initials: PR
authors.lastname: Soulos
authors.affiliation: Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Brigid K
authors.initials: BK
authors.lastname: Killelea
authors.affiliation: Department of Surgery, Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Donald R
authors.initials: DR
authors.lastname: Lannin
authors.affiliation: Department of Medicine, Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Maysa M
authors.initials: MM
authors.lastname: Abu-Khalaf
authors.affiliation: Department of Medicine, Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Michael P
authors.initials: MP
authors.lastname: DiGiovanna
authors.affiliation: Department of Medicine, Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Tara B
authors.initials: TB
authors.lastname: Sanft
authors.affiliation: Department of Medicine, Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Lajos
authors.initials: L
authors.lastname: Pusztai
authors.affiliation: Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Cary P
authors.initials: CP
authors.lastname: Gross
authors.affiliation: Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Anees B
authors.initials: AB
authors.lastname: Chagpar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000706:statistics & numerical data*; D009367:Neoplasm Staging; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
keywords: antineoplastic combined chemotherapy protocols; breast neoplasms; drug therapy; health services research; mastectomy; neoadjuvant therapy