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Chemotherapy in Women with Breast Cancer
- Xianglin L. Du, MD, PhD; and
- Charles R. Key, MD, PhD
- From University of Texas Medical Branch; Galveston, TX 77555. From University of New Mexico; Albuquerque, NM 87131.
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IN RESPONSE:
Liebmann and colleagues correctly point out a typo for chemotherapy codes in the Methods section of our article. The numbers of cases for the 7 code categories in 5101 women should be 3574, 129, 21, 1248, 61, 68, and 0, respectively. However, we did not imply that 71% of women with breast cancer were undertreated with chemotherapy. In the 1990 NIH guidelines, adjuvant chemotherapy was not recommended in all women with stage I to IIIA disease. Therefore, it is important to separate cases into 2 groups: 1 group in which chemotherapy was generally recommended, and another group in which chemotherapy was discretionary. In the first group of 2486 women, 1854 were younger than age 70 years; of these, 61.3% received adjuvant chemotherapy. The percentage of women receiving chemotherapy was 77.4% for those younger than 45 years of age, 58.1% for those 55 to 59 years of age, 37.7% for those 60 to 64 years of age, and only 25% for those 65 to 69 years of age, as shown in our Results section. Clearly there is substantial room for improvement in use of adjuvant chemotherapy.
We agree with Liebmann and colleagues that the conclusion in the Editors' Notes was not supported by the study. Because our study did not address whether those who received chemotherapy survived longer than those who did not, it is difficult to conclude that many unnecessary deaths could have been prevented if guidelines were followed.
As we discussed in our article, SEER information on chemotherapy may be incomplete. Harlan and associates provide analyses of the sensitivity of the SEER information on chemotherapy use. Because their estimates were combined for all SEER registries, it is still unknown how their findings could be generalized to our study population, given substantial geographical variations in chemotherapy use (1, 2). It is also unclear whether the sensitivity of the SEER chemotherapy data varies by tumor stage. The internal validity of chemotherapy data in our study appeared good. For example, among women with stage IIIA disease, 96% of those younger than 45 years of age, 92% of those 45 to 49 years of age, and 94% of those 50 to 54 years of age were recorded as having received adjuvant chemotherapy. Older age is an important, well-known factor for receiving less than definitive therapy (1, 2). However, what is interesting, and what was one of the key findings in our study, is that there was a marked decreasing pattern of chemotherapy use with age that could be explained in part by age-related decreasing efficacy of chemotherapy (3). This seems unique to women with breast cancer; no decreasing efficacy of chemotherapy with advanced age has been found for men and women with lung and colon cancer (4, 5).
Xianglin L. Du, MD, PhD
University of Texas Medical Branch; Galveston, TX 77555
Charles R. Key, MD, PhD
University of New Mexico; Albuquerque, NM 87131
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
