Different risk factors for mortality in younger and older women after breast-conserving surgery.

6017 Background: We previously reported that death rates were higher among women who had breast conserving surgery (BCS) but no adjuvant radiation. Here, we investigate factors associated with overall survival after BCS in younger and older women. METHODS: Women were included if they had BCS, according to the North Carolina Cancer Registry (1998 to 2002), for localized or regional, nonmetastatic breast cancer. Data were linked to Medicare and Medicaid claims, and National Death Index (NDI). Multivariate analyses, by age <70 and 70 and older, included: age; race; comorbidity; insurance status; tumor size; number of lymph nodes positive; hormone receptor status; receipt of optimal radiation (> 15 treatment sessions); adjuvant chemotherapy; receipt of preventive care - including mammography, Pap smear and primary care visits; and hospitalization. The primary outcome was overall death. RESULTS: We identified 1,719 women (mean 71.3 years, range 29-101), with 615 (36%) over age 70 and older. In multivariate analyses, receipt of optimal radiation predicted overall survival for younger (HR 0.33, 95% CI 0.13-0.84) and older (HR 0.58, 95% CI 0.38-0.89) women. None of the other factors were significant predictors of overall survival in younger women, but in older women, older age (HR 1.07 95% CI 1.03-1.10), higher comorbidity level (HR 1.14, 95% CI 1.04-1.25), larger log tumor size (HR 1.64, 95% CI 1.24-2.18), and fewer primary care visits (HR 0.64, 95% CI 0.43-0.94) were significant. CONCLUSIONS: Receipt of suboptimal radiation therapy predicts higher mortality in young and old women managed with BCS in this sample of Medicare and Medicaid-insured women. Attention to primary care in older women may be important in decreasing mortality in older women surviving breast cancer.

Duke Scholars

Author Gretchen Genevieve Kimmick Medicine, Medical Oncology