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Dissemination of adjuvant multiagent chemotherapy and tamoxifen for breast cancer in the United States using estrogen receptor information: 1975-1999.

Abstract

BACKGROUND

Clinical trials have shown tamoxifen to be effective only in women with estrogen receptor (ER)-positive tumors. In a previous model, trends in the utilization of adjuvant therapy were modeled only as a function of age and stage of the disease and not ER status. In this paper, we integrate this previous estimate on the use of adjuvant systemic therapy for breast cancer in the United States with information on ER status from the Patterns of Care (POC) data to estimate the dissemination of adjuvant therapy for women with different ER-status tumors. We also summarize efficacy of adjuvant systemic therapy reported in the overviews of early breast cancer clinical trials. These two inputs, dissemination and efficacy, are key pieces for models that investigate the effect of breast cancer adjuvant therapy on the decline of U.S. breast cancer mortality.

METHODS

The adjustments to the previous models are calculated using the POC data on 7116 women with breast cancer diagnosed from 1987 to 1991 and in 1995 who were randomly selected from the Surveillance, and Epidemiology, and End Results (SEER) program registries. The POC data provide more accurate information on treatment and clinical variables (e.g., ER status) than the SEER data because medical records are reabstracted and further verified with treating physicians.

RESULTS

Use of multiagent chemotherapy is higher for younger women (<50 years) and for women whose tumors were shown to be ER negative or borderline. The use of tamoxifen is higher among older women and women with ER-positive tumors. After 1980 the combined use of multiagent chemotherapy and tamoxifen for women diagnosed with breast cancer at ages 69 or younger increased more for women whose tumors were ER status positive or unknown than ER status negative. Older women (>69 years) seem to receive almost exclusively tamoxifen irrespective of ER status, except for a small percentage of those with more advanced stages (II- and II+/IIIA) who also receive multiagent chemotherapy.

DISCUSSION

The estimated dissemination trends by ER status, based on modeling the POC data, reveal that treatment strategies with demonstrated efficacy in clinical trials have been adopted into practice. The dissemination and efficacy are the two factors necessary to input into models to determine the population impact of these therapies on U.S. breast cancer mortality. The largest decline in mortality would be expected for younger women (<60 years) with ER-positive tumors or whose tumors are of unknown status because of the largest efficacy and dissemination of adjuvant therapy in this group.

Authors+Show Affiliations

Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892-8317, USA. mariotta@mail.nih.govNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17032888

Citation

Mariotto, Angela B., et al. "Dissemination of Adjuvant Multiagent Chemotherapy and Tamoxifen for Breast Cancer in the United States Using Estrogen Receptor Information: 1975-1999." Journal of the National Cancer Institute. Monographs, 2006, pp. 7-15.
Mariotto AB, Feuer EJ, Harlan LC, et al. Dissemination of adjuvant multiagent chemotherapy and tamoxifen for breast cancer in the United States using estrogen receptor information: 1975-1999. J Natl Cancer Inst Monographs. 2006.
Mariotto, A. B., Feuer, E. J., Harlan, L. C., & Abrams, J. (2006). Dissemination of adjuvant multiagent chemotherapy and tamoxifen for breast cancer in the United States using estrogen receptor information: 1975-1999. Journal of the National Cancer Institute. Monographs, (36), 7-15.
Mariotto AB, et al. Dissemination of Adjuvant Multiagent Chemotherapy and Tamoxifen for Breast Cancer in the United States Using Estrogen Receptor Information: 1975-1999. J Natl Cancer Inst Monographs. 2006;(36)7-15. PubMed PMID: 17032888.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dissemination of adjuvant multiagent chemotherapy and tamoxifen for breast cancer in the United States using estrogen receptor information: 1975-1999. AU - Mariotto,Angela B, AU - Feuer,Eric J, AU - Harlan,Linda C, AU - Abrams,Jeffrey, PY - 2006/10/13/pubmed PY - 2007/1/17/medline PY - 2006/10/13/entrez SP - 7 EP - 15 JF - Journal of the National Cancer Institute. Monographs JO - J. Natl. Cancer Inst. Monographs IS - 36 N2 - BACKGROUND: Clinical trials have shown tamoxifen to be effective only in women with estrogen receptor (ER)-positive tumors. In a previous model, trends in the utilization of adjuvant therapy were modeled only as a function of age and stage of the disease and not ER status. In this paper, we integrate this previous estimate on the use of adjuvant systemic therapy for breast cancer in the United States with information on ER status from the Patterns of Care (POC) data to estimate the dissemination of adjuvant therapy for women with different ER-status tumors. We also summarize efficacy of adjuvant systemic therapy reported in the overviews of early breast cancer clinical trials. These two inputs, dissemination and efficacy, are key pieces for models that investigate the effect of breast cancer adjuvant therapy on the decline of U.S. breast cancer mortality. METHODS: The adjustments to the previous models are calculated using the POC data on 7116 women with breast cancer diagnosed from 1987 to 1991 and in 1995 who were randomly selected from the Surveillance, and Epidemiology, and End Results (SEER) program registries. The POC data provide more accurate information on treatment and clinical variables (e.g., ER status) than the SEER data because medical records are reabstracted and further verified with treating physicians. RESULTS: Use of multiagent chemotherapy is higher for younger women (<50 years) and for women whose tumors were shown to be ER negative or borderline. The use of tamoxifen is higher among older women and women with ER-positive tumors. After 1980 the combined use of multiagent chemotherapy and tamoxifen for women diagnosed with breast cancer at ages 69 or younger increased more for women whose tumors were ER status positive or unknown than ER status negative. Older women (>69 years) seem to receive almost exclusively tamoxifen irrespective of ER status, except for a small percentage of those with more advanced stages (II- and II+/IIIA) who also receive multiagent chemotherapy. DISCUSSION: The estimated dissemination trends by ER status, based on modeling the POC data, reveal that treatment strategies with demonstrated efficacy in clinical trials have been adopted into practice. The dissemination and efficacy are the two factors necessary to input into models to determine the population impact of these therapies on U.S. breast cancer mortality. The largest decline in mortality would be expected for younger women (<60 years) with ER-positive tumors or whose tumors are of unknown status because of the largest efficacy and dissemination of adjuvant therapy in this group. SN - 1052-6773 UR - https://www.unboundmedicine.com/medline/citation/17032888/Dissemination_of_adjuvant_multiagent_chemotherapy_and_tamoxifen_for_breast_cancer_in_the_United_States_using_estrogen_receptor_information:_1975_1999_ L2 - https://academic.oup.com/jncimono/article-lookup/doi/10.1093/jncimonographs/lgj003 DB - PRIME DP - Unbound Medicine ER -