The effect of less than definitive care on breast carcinoma recurrence andmortality

BACKGROUND. Risk factors for breast carcinoma offer few opportunities for p revention; thus, the reduction of morbidity and mortality among breast carc inoma patients must remain a priority. The objective of this study was to m easure the effects; of less than definitive care for patients with breast c arcinoma on disease recurrence and mortality. METHODS. The prognostic evaluation and treatment received by an inception c ohort of 494 women was characterized. Three hundred ninety women ages 45-90 years with local or regional breast carcinoma who were diagnosed between 1 984 and 1986 and were treated at one of eight Rhode Island hospitals compri sed the final cohort. Disease recurrence and mortality were ascertained thr ough December 31, 1996. Candidate determinants of outcomes were a less than definitive prognostic evaluation and less than definitive primary therapy- adjusted for confounding by patient age, extent of disease, and comorbid di seases. RESULTS, During the first 5 years of follow-up, patients who received a les s than definitive prognostic evaluation had an adjusted relative hazard of recurrence of 1.7 (95% confidence interval, 1.0-2.7) and an adjusted relati ve hazard for breast carcinoma mortality of 2.2 (95% confidence interval, 1 .2-3.9). Patients who received less than definitive therapy had an adjusted relative hazard of recurrence of 1.6 (95% confidence interval, 1.0-2.5), a nd an adjusted relative hazard of breast carcinoma mortality of 1.7 (95% co nfidence interval, 1.0-2.8). CONCLUSIONS. Breast carcinoma patients who receive less than definitive car e are at excess risk for disease recurrence and mortality. Women with early stage breast carcinoma should be treated in accordance with existing guide lines. Cancer 2000; 89:1739-47. (C) 2000 American Cancer Society.