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Breast Cancer Surveillance Consortium: Working together to advance breast cancer research
 
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Comparative Effectiveness of Breast Surgery in Clinical Practice

Grant number: U01CA070013-15S1
PI Name: Geller B
Title: Comparative Effectiveness of Breast Surgery in Clinical Practice


Women 65 years and older make up about half of the new breast cancer patients each year, and the absolute number of patients is expected to double over the next 20 years. Despite their large numbers, over the past several decades when older women develop breast cancer, they often do not receive treatment consistent with guidelines. This may be because we do not have data from randomized controlled trials about how treatment may affect older women, or due to co-morbidities not present in younger women, or perhaps due to inherent bias toward cancer in this patient population. This CER proposal will examine a head-to-head comparison of different surgical options as they are practiced in the community across three points in the continuum of care: detection, diagnosis and surgical treatment. Our four aims are:

  1. To learn to use the newly acquired Medicare/VBCSS linked data by examining questions related to the quality of breast cancer surgery;
  2. To conduct comparative effectiveness research about the quality of breast cancer surgery in Vermont for women 65 and older who are covered by Medicare with respect to three clearly defined performance metrics (preoperative diagnosis, positive margin rate, breast conserving surgery) by examining variations in patterns of surgical care and effect on outcomes (local recurrence, complications, time to adjuvant therapy);
  3. To determine whether institutional volume, surgeon volume, and patient demographics, risk factors and co-morbidities influence the choice of various options and the outcomes of these three performance metrics;
  4. To mentor Dr. Ted James, surgical oncologist, to facilitate his transition to an independent clinical cancer researcher.