Evidence map›Paper›PMID 41043195›Full record

ArticleEuropean journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology2025

Geographic variation in surgery rates among older patients with early (ER positive HER2 negative) breast cancer: Influence of cardiovascular disease and comorbidities: A national registry dataset analysis.

Emma Crewe, Freya Tyrer, John Deanfield, Mark de Belder, Jennifer Lai, Mamas Mamas, David Adlam, Alistair Ring

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Article in European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Emma CreweBreast Unit - Department of Medicine, The Royal Marsden NHS Foundation Trust UK, and Nuffield Department of Primary Care Heath Sciences, University of Oxford, UK.
Freya TyrerLeicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, UK.
John DeanfieldInstitute of Cardiovascular Sciences, University College London, London, UK.
Mark de BelderNational Institute for Cardiovascular Outcomes Research, NHS Arden and Greater East Midlands Commissioning Support Unit, London, UK.
Jennifer LaiNational Disease Registration Service, NHS England, UK.
Mamas MamasACI Audit Lead, School of Medicine, Keele University, UK.
David AdlamDepartment of Cardiovascular Sciences, University of Leicester and Leicester National Institute of Health Research Biomedical Research Centre, Glenfield Hospital, Leicester, UK; The University Hospitals of Leicester NHS Trust, Leicester, UK; Leicester British Heart Foundation Centre of Research Excellence, UK. Electronic address: da134@leicester.ac.uk.
Alistair RingBreast Unit - Department of Medicine, The Royal Marsden NHS Foundation Trust, UK. Electronic address: alistair.ring@rmh.nhs.uk.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionWomen over 70 years of age with operable oestrogen receptor positive (ER positive) breast cancer have worse survival outcomes than younger women. Primary surgery is the optimal treatment with primary endocrine therapy reserved for patients who are unfit or who have multiple co-morbidities. Inferior outcomes in this patient population might be explained by underuse of surgery, the rates of which vary considerably between geographical regions in the UK. We determined the rates of surgery versus primary endocrine therapy in a cohort of women aged over 70 in England, with potentially curable ER positive breast cancer, according to the presence of pre-existing cardiovascular disease (CVD), comorbidities, social deprivation, and by geographical location. MATERIALS AND

methods33,235 women aged 70 years or older with stage I to III ER positive breast cancer from the 20 regional NHS Cancers Alliances in England were identified from the cancer registry. Linked hospital records were used to identify patient demographics, tumour and treatment characteristics, resection rates, CVD prevalence and other co-morbidities.

results25,800 (77.6 %) patients underwent surgery, 6787 (20.4 %) patients received primary endocrine therapy alone, 648 (2 %) patients received no treatment. Both CVD and surgery prevalence varied by geographical location. After adjustment for case mix the differences between Cancer Alliances attenuated and no longer reached statistical significance.

conclusionsWe found regional differences in rates of surgery in patients with breast cancer across different centres. After adjustments, the variation is largely attributable to case mix. Under recording of endocrine therapy data in secondary care limits full interpretation.

Indexed as

Breast NeoplasmsCardiovascular DiseasesMastectomyAgedAged, 80 and overComorbidityEnglandErb-b2 Receptor Tyrosine KinasesFemaleHumansNeoplasm StagingReceptors, EstrogenRegistriesErb-b2 Receptor Tyrosine KinasesReceptors, EstrogenBreast cancerCardiovascular diseaseOlder adultsSurgery

Identifiers

PMID41043195
PMCPMC12673996

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.