A Comparative Analysisof Male versus Female Breast Cancer in the ACS NSQIP Database Lindsay Petersen, MD Rush University Medical Center Chicago, IL I would like to recognize my coauthors: Andrea Madrigrano, MD and John Kubasiak, MD We have no disclosures. 1
Introduction Two recent database studies have shown decreased survival in men compared to women diagnosed with breast cancer (1-2). The purpose of this study was to compare patient demographics and postoperative outcomes between men and women with breast cancer using the ACS NSQIP database. REFERENCES 1. Nilsson et al. Similarities and differences in the characteristics and primary treatment of breast cancer in men and women a population based study (Sweden). Acta Oncologica 2011; 50: 1083-8. 2. Nahleh et al. Male Breast Cancer in the Veterans Affairs Population. Wiley InterScience 2007. Methods Male and female breast cancer patients between July 1, 2010, and July 1, 2012, were identified using ICD9 codes in the ACS NSQIP database. Demographics and outcomes were compared. Analyses using Fisher exact probability tests, unpaired t-tests, and Chi-square tests were conducted where applicable (www.vassarstats.net). 2
375 patients identified: 335 female and 40 male Male breast cancer patients accounted for 11% of the cases No statistically significant differences in postoperative outcomes 30-day mortality rate was 0% in both groups Table 1. Postoperative outcomes Female(n=335) Male(n=40) p value 30 day mortality 0% (0) 0% (0) 1 Superficial incision infection 1.2% (4) 2.5% (1) 0.999 Deep incision infection 1.2%(4) 0% (0) 1 Wound disruption 0.6% (2) 0% (0) 1 Graft/prosthesis/flap failure 0.6% (2) 0%(0) 1 Pneumonia 0%(0) 0% (0) 1 Pulmonary embolism 0% (0) 0% (0) 1 On ventilator > 48 hours 0% (0) 0% (0) 1 Acute renal failure 0% (0) 0% (0) 1 Urinary tract infection 0.6%(2) 0% (0) 1 Cerebrovascular accident 0.3% (1) 0% (0) 1 Cardiac arrest requiring CPR 0% (0) 0% (0) 1 Myocardial infarction 0% (0) 0% (0) 1 Transfusion Intraop/Postop 2.1% (7) 2.5% (1) 1 Deep venous thrombosis 0%(0) 0% (0) 1 Unplanned return to OR 6.3% (21) 2.5% (1) 0.492 Average hospital LOS 0.3(2.4) 0.9 (1.1) 0.120 3
Preoperative patient characteristics were similar in both groups, other than the male group had more patients: With history of previous cardiac surgery (p=0.013) Currently on dialysis or requiring dialysis (p=0.001) Table 2. Preoperative characteristics Female (n=335) Male (n=40) pvalue Age in years 63.2 (14.4) 67.4 (14.4) 0.098 Body mass index 28.5 (7.3) 30.7 (8.3) 0.077 American Indian or Alaskan 0% (0) 0% (0) 1 Asian 3.6% (12) 5% (2) 0.652 Black or African American 6% (20) 10% (4) 0.493 Hispanic Ethnicity 5.1% (17) 2.5% (1) 0.706 White 76.1% (255) 72.5% (11) 0.696 Native Hawaiian 0% (0) 0% (0) 1 Non-insulin DM 9.6%(32) 2.5% (1) 0.155 Insulin DM 6.3% (21) 2.5% (1) 0.492 Current smoker 12.5% (42) 5% (2) 0.200 Alcohol use (>2 drinks per day) 0.9% (3) 0% (0) 1 DNR status 0.6% (2) 0% (0) 1 4
Table 2. Preoperative characteristics Female (n=335) Male (n=40) pvalue Dyspnea with moderate exertion 7.5% (25) 10% (4) 0.754 Dyspnea at rest 0.3% (1) 0% (0) 1 History of severe COPD 5.1% (17) 5% (2) 0.750 Current pneumonia 0% (0) 0% (0) 1 Congestive heart failure 0.3% (1) 0% (0) 1 History of myocardial infarction 0% (0) 0% (0) 1 Previous percutaneous cocronary intervention 1.2% (4) 5%(2) 0.126 Previous cardiac surgery 0.3% (1) 5% (2) 0.031 History of angina 0.6%(2) 0% (0) 1 Hypertension requiring medication 45.1%(151) 55% (22) 0.245 Ascites 0% (0) 0% (0) 1 Acute renal failure 0% (0) 0% (0) 1 Requiring dialysis 0% (0) 7.5% (3) 0.001 Table 2. Preoperative characteristics Female (n=335) Male (n=40) pvalue History of transient ischemic attack 3% (10) 0%(0) 0.399 Cerebrovascular accident without deficit 0.9% (3) 0% (0) 1 Cerebrovascular accident with deficit 0.9% (3) 2.5%(1) 0.364 Disseminated cancer 1.8% (6) 2.5%(1) 1 Chemotherapy 3.9% (13) 2.5% (1) 1 Radiotherapy 0.3% (1) 0% (0) 1 Bleeding disorder 3% (10) 0% (0) 0.399 Preoperative transfusions 0% (0) 0% (0) 1 History of revascularization or amputation 0.9% (3) 0% (0) 1 Open wound 1.5% (5) 0% (0) 1 Steroid use 2.1% (7) 5%(2) 0.623 10% loss of body weight 0.3%(1) 0% (0) 1 Pregnancy 0% (0) 0% (0) 1 Prior Operation within 30 days 1.2% (4) 2.5%(1) 0.999 5
Conclusions This is the first study comparing the preoperative patient characteristics and postoperative outcomes between male and female breast cancer patients undergoing breast surgery in the ACS NSQIP database. There was no difference in survival rate, unlike other database studies, which have shown decreased survival for male breast cancer patients, although only data for the first thirty days following surgery is collected in the NSQIP database. Conclusions There was no difference in patient demographics in regard to race or age, which may indicate that the presentation of breast cancer is more similar between the genders than initially shown in other database studies. 6