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Article

Associated Factors and Survival Outcomes for Breast Conserving Surgery versus Mastectomy among New Zealand Women with Early-Stage Breast Cancer

1
Section of Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland 1142, New Zealand
2
Department of NIDEA (National Institute of Demographic and Economic Analysis), Waikato Medical Research Centre, The University of Waikato, Hamilton 3240, New Zealand
3
Department of Strategy, Investment and Transformation, Waikato District Health Board, Hamilton 3204, New Zealand
4
Breast and General Surgeon, Waikato Hospital, Hamilton 3204, New Zealand
*
Author to whom correspondence should be addressed.
Academic Editors: Matteo Franchi, Anna Cantarutti and Federico Rea
Int. J. Environ. Res. Public Health 2021, 18(5), 2738; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18052738
Received: 8 February 2021 / Revised: 24 February 2021 / Accepted: 25 February 2021 / Published: 8 March 2021
(This article belongs to the Special Issue Real-World Evidence in Clinical Epidemiology and Public Health)
This study aimed to investigate type of loco-regional treatment received, associated treatment factors and mortality outcomes in New Zealand women with early-stage breast cancer who were eligible for breast conserving surgery (BCS). This is a retrospective analysis of prospectively collected data from the Auckland and Waikato Breast Cancer Registers and involves 6972 women who were diagnosed with early-stage primary breast cancer (I-IIIa) between 1 January 2000 and 31 July 2015, were eligible for BCS and had received one of four loco-regional treatments: breast conserving surgery (BCS), BCS followed by radiotherapy (BCS + RT), mastectomy (MTX) or MTX followed by radiotherapy (MTX + RT), as their primary cancer treatment. About 66.1% of women received BCS + RT, 8.4% received BCS only, 21.6% received MTX alone and 3.9% received MTX + RT. Logistic regression analysis was used to identify demographic and clinical factors associated with the receipt of the BCS + RT (standard treatment). Differences in the uptake of BCS + RT were present across patient demographic and clinical factors. BCS + RT was less likely amongst patients who were older (75+ years old), were of Asian ethnicity, resided in impoverished areas or areas within the Auckland region and were treated in a public healthcare facility. Additionally, BCS + RT was less likely among patients diagnosed symptomatically, diagnosed during 2000–2004, had an unknown tumour grade, negative/unknown oestrogen and progesterone receptor status or tumour sizes ≥ 20 mm, ≤50 mm and had nodal involvement. Competing risk regression analysis was undertaken to estimate the breast cancer-specific mortality associated with each of the four loco-regional treatments received. Over a median follow-up of 8.8 years, women who received MTX alone had a higher risk of breast cancer-specific mortality (adjusted hazard ratio: 1.38, 95% confidence interval (CI): 1.05–1.82) compared to women who received BCS + RT. MTX + RT and BCS alone did not have any statistically different risk of mortality when compared to BCS + RT. Further inquiry is needed as to any advantages BCS + RT may have over MTX alternatives. View Full-Text
Keywords: breast conserving therapy; mastectomy; survival; associated factors breast conserving therapy; mastectomy; survival; associated factors
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MDPI and ACS Style

Abrahimi, M.S.; Elwood, M.; Lawrenson, R.; Campbell, I.; Tin Tin, S. Associated Factors and Survival Outcomes for Breast Conserving Surgery versus Mastectomy among New Zealand Women with Early-Stage Breast Cancer. Int. J. Environ. Res. Public Health 2021, 18, 2738. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18052738

AMA Style

Abrahimi MS, Elwood M, Lawrenson R, Campbell I, Tin Tin S. Associated Factors and Survival Outcomes for Breast Conserving Surgery versus Mastectomy among New Zealand Women with Early-Stage Breast Cancer. International Journal of Environmental Research and Public Health. 2021; 18(5):2738. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18052738

Chicago/Turabian Style

Abrahimi, Mohammad S., Mark Elwood, Ross Lawrenson, Ian Campbell, and Sandar Tin Tin. 2021. "Associated Factors and Survival Outcomes for Breast Conserving Surgery versus Mastectomy among New Zealand Women with Early-Stage Breast Cancer" International Journal of Environmental Research and Public Health 18, no. 5: 2738. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18052738

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