An estimated 192,200 women were diagnosed with breast cancer in 2001, more than half of whom were 60 years of age or older. Of concern is that while breast cancer-specific mortality rates have declined among women less than 70 years old, they are either stable (70-79 year olds) or are increasing (80+ year olds) among those 70 years or older. One explanation for this is that older women receive less than standard therapy more frequently than younger women. Neither efficacy nor effectiveness data to date justify this pattern of care. Taking advantage of the Health Maintenance Organization (HMO) Cancer Research Network, we propose to conduct a historical cohort study of an unselected group of older women (>65 years of age) newly diagnosed with early stage breast cancer (stages I-II) between 1990 and 1994. Specifically, we will (1) Compare the effectiveness of standard primary tumor therapy (breast conserving surgery, axillary dissection, and radiation therapy or modified radical mastectomy) versus other than standard therapy in preventing breast cancer recurrences and mortality, adjusting for co-morbidity, tumor characteristics, geographic site, and demographic characteristics; (2) Determine the extent to which the addition of systemic adjuvant therapy (chemotherapy, hormonal therapy, or the combination of chemotherapy and hormonal therapy) modifies the effectiveness of standard and other than standard primary tumor therapy in preventing breast cancer recurrences and mortality; (3) Describe patterns of surveillance testing for breast cancer recurrence and determine the extent to which surveillance testing is associated with a reduction in breast cancer-specific mortality; and (4) Identify provider, tumor, and patient characteristics associated with the receipt of standard primary tumor therapy and systemic adjuvant therapy in older women with newly diagnosed early stage disease in the HMO setting. Six sites from throughout the United States will together identify and follow 2180 women for ten years. Both electronic and medical record data sources will be used to collect information that will allow us to characterize the separate and joint effects of treatment, tumor, and patient characteristics on breast cancer recurrence and mortality. Findings from this study will inform clinical practice, particularly the care of older women with co-morbidities who are unlikely to participate in clinical trials.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
3R01CA093772-04S1
Application #
7171685
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Ogunbiyi, Peter
Project Start
2003-02-10
Project End
2006-06-30
Budget Start
2006-01-01
Budget End
2006-06-30
Support Year
4
Fiscal Year
2006
Total Cost
$37,564
Indirect Cost
Name
Boston Medical Center
Department
Type
DUNS #
005492160
City
Boston
State
MA
Country
United States
Zip Code
02118
Wirtz, Heidi S; Calip, Gregory S; Buist, Diana S M et al. (2017) Evidence for Detection Bias by Medication Use in a Cohort Study of Breast Cancer Survivors. Am J Epidemiol 185:661-672
Haque, Reina; Shi, Jiaxiao; Schottinger, Joanne E et al. (2016) Tamoxifen and Antidepressant Drug Interaction in a Cohort of 16,887 Breast Cancer Survivors. J Natl Cancer Inst 108:
Chlebowski, Rowan T; Schottinger, Joanne E; Shi, Jiaxiao et al. (2015) Aromatase inhibitors, tamoxifen, and endometrial cancer in breast cancer survivors. Cancer 121:2147-55
Jordan, Jennifer H; Thwin, Soe Soe; Lash, Timothy L et al. (2014) Incident comorbidities and all-cause mortality among 5-year survivors of Stage I and II breast cancer diagnosed at age 65 or older: a prospective-matched cohort study. Breast Cancer Res Treat 146:401-9
Haque, Reina; Prout, Marianne; Geiger, Ann M et al. (2014) Comorbidities and cardiovascular disease risk in older breast cancer survivors. Am J Manag Care 20:86-92
Carrell, David S; Halgrim, Scott; Tran, Diem-Thy et al. (2014) Using natural language processing to improve efficiency of manual chart abstraction in research: the case of breast cancer recurrence. Am J Epidemiol 179:749-58
Lash, Timothy L; Thwin, Soe Soe; Yood, Marianne Ulcickas et al. (2014) Comprehensive evaluation of the incidence of late effects in 5-year survivors of breast cancer. Breast Cancer Res Treat 144:643-63
Boudreau, Denise M; Yu, Onchee; Chubak, Jessica et al. (2014) Comparative safety of cardiovascular medication use and breast cancer outcomes among women with early stage breast cancer. Breast Cancer Res Treat 144:405-16
Wirtz, Heidi S; Boudreau, Denise M; Gralow, Julie R et al. (2014) Factors associated with long-term adherence to annual surveillance mammography among breast cancer survivors. Breast Cancer Res Treat 143:541-50
Clough-Gorr, Kerri M; Thwin, Soe Soe; Bosco, Jaclyn L F et al. (2013) Incident malignancies among older long-term breast cancer survivors and an age-matched and site-matched nonbreast cancer comparison group over 10 years of follow-up. Cancer 119:1478-85

Showing the most recent 10 out of 30 publications