Patterns of nodal staging during breast conservati

Authors: Catherine E LovelandJones Karen Ruth Elin R Sigurdson Brian L Egleston Marcia Boraas Richard J Bleicher

Publish Date: 2014/01/19

Volume: 143, Issue: 3, Pages: 571-577

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Abstract

ACOSOG Z0011 spares axillary dissection AD in breast conservation surgery BCS patients with T1/T2 tumors and 1–2 positive nodes Current patterns of care and the impact of Z0011 on AD versus additional surgery rates for Medicare patients undergoing BCS are unknown SEER data linked to Medicare claims for 1999–2005 were reviewed for women with invasive nonmetastatic breast cancer who underwent nodal staging on the same day as BCS There were 3280 women with T1/T2 tumors and positive nodes who underwent sameday nodal staging 2532 772  of these women had 1–2 positive nodes Assuming 257  have extracapsular extension 651 women would require AD However 1881 women or 574  of those with T1/T2 tumors and positive nodes would be spared AD Meanwhile among the 748 women having ≥3 positive nodes 579 underwent sameday AD but under Z0011 would now wait for permanent section A total of 160 of these women underwent reexcision or completion mastectomy at a later date anyway when delayed AD could be performed The remaining 419 women with ≥3 positive nodes would require an additional surgery date for the sole purpose of completion AD The Z0011 paradigm would consequently necessitate an additional surgery date for 1070 651 + 419 women or 326  of those with T1/T2 tumors and positive nodes The Z0011 paradigm appears to increase the number of Medicare patients undergoing BCS who require an additional surgery date but decrease the number requiring AD to a greater extent Future changes in the use of AD or axillary irradiation may yet modify that impact substantiallySupported in part by US Public Health Services Grant P30 CA006927 by an appropriation from the Commonwealth of Pennsylvania by American Cancer Society Grant IRG9202717 and by generous private donor support The collection of the California Cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885 the National Cancer Institute’s Surveillance Epidemiology and End Results Program under Contract N01PC35136 awarded to the Northern California Cancer Center Contract N01PC35139 awarded to the University of Southern California and Contract N02PC15105 awarded to the Public Health Institute and the Centers for Disease Control and Prevention’s National Program of Cancer Registries under Agreement U55/CCR92193002 awarded to the Public Health Institute The ideas and opinions expressed herein are those of the authors and endorsement by the State of California Department of Public Health the National Cancer Institute and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred The authors acknowledge the efforts of the Applied Research Program NCI the Office of Research Development and Information CMS Information Management Services IMS Inc and the Surveillance Epidemiology and End Results SEER Program tumor registries in the creation of the SEER–Medicare database

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