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Background and Aim of the Work: Breast cancer is the most common cancer in women in the United States. National Cancer Database (NCDB) is one of the largest tumor databases of the United States. This study aimed to evaluate the features of breast cancer in women from a large updated database., Methods: We describe and analyze the frequencies and percentages of the clinical and pathological features of women diagnosed with breast cancer registered in NCDB, in a period from 2004 to 2015., Results: A total of 2,423,875 women were diagnosed with breast cancer between 2004 and 2015. The nationally representative analysis demonstrated that the incidence of breast cancer among women increased over the years. Upper-outer quadrant was the most frequent primary tumor site, and the intraductal carcinoma was the most frequent histology. The prevalence of breast cancer increased with age. The most frequent grade at diagnosis was grade II. Broadly, invasive characteristics were noted more frequently in younger patients. Left and right breast were affected with almost the same frequency, with a slight predominance of the left breast. The most frequent surgical treatment was a partial mastectomy. Reconstruction with implant was the most frequent choice. Post-mastectomy radiation therapy was administered in the majority of patients., Conclusions: To the authors' knowledge, the current study is the largest descriptive analysis to date on the clinical and pathological features of breast cancer in a population-based database. The increase in incidence over the years indicates an important need for etiologic research and innovative approaches to improve breast cancer prevention.

Background: Paget's disease of the breast is rare. The National Cancer Database (NCDB) is one of the largest tumor databases in the United States., Methods: We queried the NCDB to identify male and female patients with Paget's disease of the breast who were treated from January 1, 2004, through December 31, 2015. No age limitations were applied. Descriptive statistical analysis and survival analysis were performed., Results: We analyzed the demographic, disease, and treatment characteristics of 7,191 patients with Paget's disease of the breast. The median (range) age was 64 (20-90) years. Only 2.1% of patients were men, and 85.4% were white. The most common treatment was complete mastectomy (65.3%), followed by partial mastectomy (30.3%). Tumor destruction was performed in 0.1% of patients, and 4.3% of patients did not undergo any surgery. We examined survival in the subset of 6,864 patients who were treated surgically with complete mastectomy or partial mastectomy. The 5-year survival rate after surgery was 82.5% (95% CI, 81.1%-83.9%). Factors associated with shorter survival were older age, black race/ethnicity, higher tumor grade, regional lymph node metastasis, higher cancer stage, metastatic cancer, and larger tumor size., Conclusions: Paget's disease of the breast usually affects patients older than 60 years, and the most common treatment is complete mastectomy. The 5-year overall survival rate of patients with Paget's disease of the breast is greater than 80% but is lower among older and black people.

Background/aim: This study aimed to analyze facility characteristics contributing to disparities in breast reconstruction access in the United States., Patients and Methods: Data from January 1, 2004, to December 31, 2015 were extracted from the National Cancer Database on patient, facility and treatment, and tumor characteristics. A total of 858,594 patients met the inclusion criteria of the study, including 553,517 (64.5%) patients who underwent mastectomy only (without breast reconstruction) and 305,077 (35.5%) patients who received breast reconstruction (implants or autologous tissue)., Results: Multivariate analysis showed that the odds of reconstruction were higher in Integrated Network Cancer Programs and Academic/Research Programs compared to Community Cancer Programs. Patients treated in the South, Midwest, and West regions had lower odds of reconstruction. Interestingly, patients treated in more than one Commission on Cancer facility had a higher likelihood of reconstruction., Conclusion: Facility characteristics and location impact on access to breast reconstruction., (Copyright© 2019, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Aim: This study describes the demographic, socioeconomic, and tumor-specific characteristics of patients who refuse breast cancer surgery., Materials and Methods: This is a retrospective study of breast cancer patients from 2004-2015 captured by the National Cancer Data Base. Demographic, socioeconomic, and tumor-specific predictors were compared between patients who refused breast cancer surgery versus those who agreed to surgery, using bivariate and multivariate models., Results: A total of 2,445,870 patients met the inclusion criteria. On multivariate analysis, black and Asian patients had higher odds of refusing surgical treatment compared to whites (OR=2.16, CI=2.05-2.28, p<0.001), (OR=1.58, CI=1.41-1.76, p<0.001), respectively. Moreover, patients with government insurance (OR=1.97, CI=1.86-2.09, p<0.001) and uninsured patients (OR=3.91, CI=3.50-4.36, p<0.001) were found to have higher odds of surgical treatment refusal when compared to patients with private insurance., Conclusion: Specific demographic and disease-specific characteristics are related to refusing potentially life-saving breast cancer surgery., (Copyright© 2019, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background/aim: The aim of this study was to analyze how race, income, insurance, and education, affect breast reconstruction rates., Materials and Methods: We reviewed the National Cancer Database. χ 2 test and binary logistic regression were used to analyze the association between demographic characteristics and reconstruction rate., Results: White race and private insurance were associated with a higher risk of getting reconstruction when compared to black race (odd ratio [OR]=0.939; 95%CI=0.909-0.970) and government insurance (OR=0.459; 95%CI=0.447-0.471). Patients with an estimated income >$63,000 were found to have higher odds of receiving breast reconstruction than patients with income less than $38,000 (OR=1.868; 95%CI=1.792-1.948). Patients who live in a zip code area with a higher education average have higher odds of receiving postmastectomy breast reconstruction than patients living in a zip code with a lower education average (OR=1.152, 95%CI=1.104-1.203)., Conclusion: Differences in reconstruction rates exist based on race, income, insurance, and education level., (Copyright© 2019, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background : In those undergoing treatment for breast cancer, evidence has demonstrated a significant improvement in survival, and a reduction in the risk of local recurrence in patients who undergo postmastectomy radiation therapy (PMRT). There is uncertainty about the optimal timing of PMRT, whether it should be before or after tissue expander or permanent implant placement. This study aimed to summarize the data reported in the literature on the effect of the timing of PMRT, both preceding and following 2-stage expander-implant breast reconstruction (IBR), and to statistically analyze the impact of timing on infection rates and the need for explantation. Methods : A comprehensive systematic review of the literature was conducted using the PubMed/Medline, Ovid, and Cochrane databases without timeframe limitations. Articles included in the analysis were those reporting outcomes data of PMRT in IBR published from 2009 to 2017. Chi-square statistical analysis was performed to compare infection and explantation rates between the two subgroups at p < 0.05. Results : A total of 11 studies met the inclusion criteria for this study. These studies reported outcomes data for 1565 total 2-stage expander-IBR procedures, where PMRT was used (1145 before, and 420 after, implant placement). There was a statistically significant higher likelihood of infection following pre-implant placement PMRT (21.03%, p = 0.000079), compared to PMRT after implant placement (9.69%). There was no difference in the rate of explantation between pre-implant placement PMRT (12.93%) and postimplant placement PMRT (11.43%). Conclusion : This study suggests that patients receiving PMRT before implant placement in 2-stage expander-implant based reconstruction may have a higher risk of developing an infection.