The Population-level Effect of Adjuvant Therapies on Breast Cancer Recurrence: Application of the Trend-in-Trend Design.

Autor:	Collin LJ; From the Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT., Waller LA; Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA., Cronin-Fenton DP; Department of Clinical Epidemiology, University and Aarhus University Hospital, Aarhus, Denmark.; Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark., Ahern TP; Department of Surgery, The Robert Larner, M.D. College of Medicine at The University of Vermont, Burlington, VT., Goodman M; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA., McCullough LE; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA., Kjærsgaard A; Department of Clinical Epidemiology, University and Aarhus University Hospital, Aarhus, Denmark.; Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark., Woolpert KM; Department of Clinical Epidemiology, University and Aarhus University Hospital, Aarhus, Denmark.; Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark., Silliman RA; Department of Medicine, Boston University School of Medicine, Boston University, Boston, MA., Christiansen PM; Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark.; Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark., Ejlertsen B; Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.; Rigshospitalet, Copenhagen, Denmark., Sørensen HT; Department of Clinical Epidemiology, University and Aarhus University Hospital, Aarhus, Denmark.; Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark., Lash TL; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
Jazyk:	angličtina
Zdroj:	Epidemiology (Cambridge, Mass.) [Epidemiology] 2024 Sep 01; Vol. 35 (5), pp. 660-666. Date of Electronic Publication: 2024 Aug 06.
DOI:	10.1097/EDE.0000000000001753
Abstrakt:	Purpose: Breast cancer has an average 10-year relative survival reaching 84%. This favorable survival is due, in part, to the introduction of biomarker-guided therapies. We estimated the population-level effect of the introduction of two adjuvant therapies-tamoxifen and trastuzumab-on recurrence using the trend-in-trend pharmacoepidemiologic study design. Methods: We ascertained data on women diagnosed with nonmetastatic breast cancer who were registered in the Danish Breast Cancer Group clinical database. We used the trend-in-trend design to estimate the population-level effect of the introduction of (1) tamoxifen for postmenopausal women with estrogen receptor (ER)-positive breast cancer in 1982, (2) tamoxifen for premenopausal women diagnosed with ER-positive breast cancer in 1999, and (3) trastuzumab for women <60 years diagnosed with human epidermal growth factor receptor 2-positive breast cancer in 2007. Results: For the population-level effect of the introduction of tamoxifen among premenopausal women diagnosed with ER-positive breast cancer in 1999, the risk of recurrence decreased by nearly one-half (OR = 0.52), consistent with evidence from clinical trials; however, the estimate was imprecise (95% confidence interval [CI] = 0.25, 1.85). We observed an imprecise association between tamoxifen use and recurrence from the time it was introduced in 1982 (OR = 1.24 95% CI = 0.46, 5.11), inconsistent with prior knowledge from clinical trials. For the introduction of trastuzumab in 2007, the estimate was also consistent with trial evidence, though imprecise (OR = 0.51; 95% CI = 0.21, 22.4). Conclusions: We demonstrated how novel pharmacoepidemiologic analytic designs can be used to evaluate the routine clinical care and effectiveness of therapeutic advancements in a population-based setting while considering some limitations of the approach. Competing Interests: The authors report no conflicts of interest. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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