A task force was created by the Belgian Society of Medical Oncology (BSMO) to monitor the quality of treatment of breast cancer in Belgium. In collaboration with the Belgian Cancer Registry an analysis of the data was performed in search of reliable quality indicators. Finding actionable differences can lead to better treatment of our patients.
Data of 48,872 patients diagnosed with invasive breast cancer between 2010 and 2014 were analysed. To enable risk stratification according to their surrogate subtype, pathology reports of year 2014 were manually checked (9,855 patients). We identified patients < 70 Y (years) and > 75 Y receiving adjuvant radiotherapy after mastectomy and the different systemic treatments in each surrogate subtype. We also calculated the total length of endocrine treatment and the percentage of chemotherapy given in first line ER+ metastatic patients.
In cStage I-III, post-mastectomy radiotherapy was administered in 70.7% of the patients <70 Y and in 46.5% of patients > 75 Y, with an important intercenter variability. 81.7% of the cStage I-III patients <70 Y received at least 4.5 years of adjuvant endocrine therapy, with a slight decrease each year. In the 2014 cohort we identified 54.4% luminal A-like, 14.9% luminal B-like HER2-, 12.4% luminal B-like HER2+, 4.6% non luminal HER2+, 8.6% triple negative and 5.1% unknown. As a negative indicator, 44.6% of the HER2+ pT1aN0 patients <70 Y received adjuvant trastuzumab, compared to 22.2% of the patients > 70 Y. As first treatment for cStage IV HR+/HER2- patients, we identified endocrine therapy in 53.9% and chemotherapy in 17.3%.
Substantial treatment differences were observed among centers. Overtreatment is an important negative quality aspect of breast cancer management. A frequent use of postmastectomy radiotherapy was observed. The use of trastuzumab was inappropriate in pT1aN0 patients. Chemotherapy was used too often in first line hormone receptor positive metastatic patients.
Clinical trial identification
Legal entity responsible for the study
Belgian Cancer Registry.
Has not received any funding.
All authors have declared no conflicts of interest.