Individualizing the locoregional management of breast cancer is challenging for both patients and their clinicians. The acceleratetd pace of introduction and adoption of evaluative tests to inform management of breast cancer may facilitate individualization, but the patterns of use and impact of these tests is not sufficiently understood. Standard treatments include breast conserving surgery (BCS) with whole breast radiation vs mastectomy, which have been shown to yield equivalent clinical outcomes in mature randomized trials. However, patients may now also receive more aggressive approaches, including contralateral prophylactic mastectomy, or less aggressive approaches, such as BCS with partial breast irradiation (PBI) or omission of axillary lymph node dissection (ALND) for limited metastases on sentinel node biopsy. The health benefits of the rapidly evolving approaches for breast cancer locoregional management cannot be maximized without ongoing population-based research to track and evaluate how these tests and treatments are used to better individualize care. Individualized care in this context is achieved when 1) evaluative tests are ordered in clinically appropriate patients, 2) treatment receipt is largely driven by evidence-based clinical indications that address expected benefit in terms of disease-free and overall survival, and 3) patients are informed, satisfied with the process, and their preferences and values are incorporated into decisions. The project proposed here is a population-based study of patients newly diagnosed with breast cancer and reported to the SEER registries of New Jersey and Georgia, as well as their surgeons.
Aim 1 is to examine the use of newer evaluative tests (breast MRI and genetic testing for BRCA1/2 mutation) for patients diagnosed with breast cancer and the patient and clinician correlates of testing.
Aim 2 is to examine the receipt of contralateral prophylactic mastectomy, omission of ALND, and PBI, and the patient and clinician correlates of uptake of these emerging approaches for locoregional management of breast cancer. As part of this aim, we will evaluate the effects of newer evaluative tests on receipt of treatments.
Aim 3 is to explore the individualization of decision-making by evaluating the extent to which patients are informed about tests and treatments and are satisfied with the decision-making process.

Public Health Relevance

Because early-stage breast cancer patients face several options for locoregional evaluation and treatment, breast cancer is an excellent model for understanding what factors promote the individualization of cancer care. Results will promote the public health by informing clinical practice and guiding interventions to improve the individualization of breast cancer care, including approaches that might be applied to other cancer types.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Research Program Projects (P01)
Project #
Application #
Study Section
Special Emphasis Panel (ZCA1-RPRB-B)
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Michigan Ann Arbor
Ann Arbor
United States
Zip Code
Katz, Steven J; Hawley, Sarah T; Hamilton, Ann S et al. (2018) Surgeon Influence on Variation in Receipt of Contralateral Prophylactic Mastectomy for Women With Breast Cancer. JAMA Surg 153:29-36
Lee, Kamaria L; Janz, Nancy K; Zikmund-Fisher, Brian J et al. (2018) What Factors Influence Women's Perceptions of their Systemic Recurrence Risk after Breast Cancer Treatment? Med Decis Making 38:95-106
Morrow, Monica; Jagsi, Reshma; McLeod, M Chandler et al. (2018) Surgeon Attitudes Toward the Omission of Axillary Dissection in Early Breast Cancer. JAMA Oncol 4:1511-1516
Radhakrishnan, Archana; Chandler McLeod, M; Hamilton, Ann S et al. (2018) Preferences for Physician Roles in Follow-up Care During Survivorship: Do Patients, Primary Care Providers, and Oncologists Agree? J Gen Intern Med :
Jagsi, Reshma; Ward, Kevin C; Abrahamse, Paul H et al. (2018) Unmet need for clinician engagement regarding financial toxicity after diagnosis of breast cancer. Cancer 124:3668-3676
Kurian, Allison W; Ward, Kevin C; Hamilton, Ann S et al. (2018) Uptake, Results, and Outcomes of Germline Multiple-Gene Sequencing After Diagnosis of Breast Cancer. JAMA Oncol 4:1066-1072
Resnicow, Ken; Patel, Minal R; Mcleod, M Chandler et al. (2018) Physician attitudes about cost consciousness for breast cancer treatment: differences by cancer sub-specialty. Breast Cancer Res Treat :
Katz, Steven J; Bondarenko, Irina; Ward, Kevin C et al. (2018) Association of Attending Surgeon With Variation in the Receipt of Genetic Testing After Diagnosis of Breast Cancer. JAMA Surg 153:909-916
Morrow, Monica; Abrahamse, Paul; Katz, Steven J (2018) Trend Analysis on Reoperation After Lumpectomy for Breast Cancer-Reply. JAMA Oncol 4:747
Gornick, Michele C; Kurian, Allison W; An, Lawrence C et al. (2018) Knowledge regarding and patterns of genetic testing in patients newly diagnosed with breast cancer participating in the iCanDecide trial. Cancer 124:4000-4009

Showing the most recent 10 out of 47 publications