br Tanderup K Fokdal LU Sturdza A Haie Meder C
 Tanderup K, Fokdal LU, Sturdza A, Haie-Meder C, Mazeron R, van Limbergen E, et al. Effect of tumor dose, volume and overall treatment time on local control after radiochemotherapy including MRI guided brachytherapy of locally advanced cervical cancer. Radiother Oncol 2016;120:441e6. Competing Risk of Death in Elderly Patients with Newly Diagnosed Stage I Breast Cancer
Nabil Wasif, MD, MPH, FACS, Matthew Neville, MS, Richard Gray, MD, FACS, Patricia Cronin, MD, Barbara A Pockaj, MD, FACS
BACKGROUND: The majority of newly diagnosed breast cancers in the US are in women aged older than 65 years who can have additional comorbidities. Balancing the risks and benefits of treatment should take into account these competing risks of death.
STUDY DESIGN: The Surveillance, Epidemiology, and End Results Program-Medicare database was used to identify women with stage I breast cancer undergoing operations from 2004-2012. Using neural network analysis, comorbidities associated with mortality were grouped into clinically relevant categories. Cumulative incidence graphs and Fine and Gray competing risk regres-sion analyses were used to study the association of age, race, comorbidity groupings, and tumor variables with 3 competing mortality outcomes: dead of disease (DOD), dead of other cancers (DOC), and non-cancer death (NCD).
RESULTS: The overall cumulative incidence of mortality was 4.9% for DOD, 3.7% for DOC, and 21.3% for NCD for the 47,220 patients studied. For all patients, the 5- and 8-year probability of DOD was 3% and 4.7%, for DOC 1.9% and 3.5%, and for NCD 9.8% and 18.9%, respectively. The presence of any major comorbidity (eg cardiovascular or neurologic disorders) significantly increased the probability of NCD, and Acetylcysteine receptor status was the strongest predictor of DOD. Given patient age, comorbidity, and estrogen receptor status, an estimate of competing risks of death from DOD, DOC, and NCD can be calculated.
CONCLUSIONS: To aid clinical decision making, we quantify competing risks of death in patients with stage I breast cancer by taking into account patient age, comorbidity, and estrogen receptor status. (J Am Coll Surg 2019;229:30e37. 2019 by the American College of Surgeons. Published by Elsevier Inc. All rights reserved.)
CME questions for this article available at http://jacscme.facs.org
Disclosure Information: Authors have nothing to disclose. Timothy J Eberlein, Editor-in-Chief, has nothing to disclose.
Support: This study was supported in part by the Mayo Clinic Robert D and Patricia E Kern Center for the Science of Health Care Delivery.
Presented at the Western Surgical Association 126th Scientific Session, San Jose del Cabo, Mexico, November 2018.
From the Department of Surgery, Division of Surgical Oncology (Wasif, Gray, Cronin, Pockaj), Robert D and Patricia E Kern Center for the Sci-ence of Health Care Delivery, Surgical Outcomes Program (Wasif, Neville), and Department of Biostatistics (Neville), Mayo Clinic Arizona, Phoenix, AZ.
Correspondence address: Nabil Wasif, MD, MPH, FACS, Department of Surgery, Division of Surgical Oncology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054. email: [email protected]
One in 8 women will be diagnosed with ductal carcinoma in situ or stage I breast cancer during their lifetime. With cur-rent multimodality treatment, the cure rate with early diag-nosis approaches 100%.1 As mortality becomes less of a concern, more attention has been directed to quality of life issues, especially the side effects of therapy. Instead of a “one size fits all” approach, treatment is being tailored ac-cording to individual patient and tumor characteristics to optimize the risk to benefit ratio for each treatment modality.