SUPPLEMENTAL MATERIAL

Patterns of Axillary Evaluation in Older Patients with Breast Cancer and Impact on Adjuvant Therapy

Laura S Dominici, MD1; Helmneh M Sineshaw, MD, MPH2; Ahmedin Jemal, DVM, PhD2; Chun Chieh Lin, MBA, PhD2; Tari A King MD1; Rachel A Freedman MD, MPH3

Supplemental Table. Adjusted odds ratios with 95% CI from multinomial logistic regression analysis for factors predicting receipt of axillary surgery versus no axillary surgery in women aged 65 years or older with clinical stage I-II breast cancer not including clinical node-positive disease (multinomial outcome)*

Category / SLNB / ALND
OR (95% CI) / OR (95% CI)
Diagnosis age
65-70 (ref) / 1.00 / 1.00
71-75 / 0.64 (0.57-0.71) / 0.62 (0.55-0.70)
76-80 / 0.33 (0.30-0.37) / 0.30 (0.27-0.34)
> 80 / 0.08(0.07-0.08) / 0.07 (0.06-0.08)
Race/Ethnicity
NH white (ref) / 1.00 / 1.00
NH black / 0.88 (0.79-0.99) / 1.08 (0.94-1.24)
Hispanic / 0.97 (0.81-1.17) / 1.21 (0.97-1.50)
Other / 0.95 (0.78-1.16) / 0.85 (0.66-1.08)
Diagnosis year
2012 (ref) / 1.00 / 1.00
2013 / 1.08 (1.02-1.15) / 0.95(0.88-1.03)
Stage
I (ref) / 1.00 / 1.00
II / 0.73 (0.66-0.81) / 0.84 (0.74-0.95)
Grade
1 (ref) / 1.00 / 1.00
2 / 1.22 (1.13-1.31) / 1.60 (1.45-1.76)
3 / 1.24 (1.12-1.38) / 1.86 (1.64-2.11)
Missing/unknown / 0.96 (0.86-1.08) / 1.15 (0.98-1.34)
Hormone receptor (ER/PR)
Positive (ref) / 1 / 1
Negative / 1.10 (0.98-1.23) / 0.99 (0.86-1.13)
Unknown / 0.35 (0.27-0.45) / 0.30 (0.21-0.42)
HER2
Positive (ref) / 1.00 / 1.00
Negative / 0.83 (0.723-0.94) / 0.75 (0.65-0.87)
Missing/unknown / 0.42 (0.35-0.51) / 0.46 (0.37-0.57)
Tumor size
≤ 2 cm (ref) / 1.00 / 1.00
> 2 cm to 5 cm / 0.98 (0.88-1.09) / 1.74 (1.54-1.97)
> 5 cm / 0.49 (0.40-0.60) / 1.59 (1.27-1.97)
Comorbidity score
0 (ref) / 1.00 / 1.00
1 / 0.84 (0.78-0.91) / 0.86 (0.78-0.95)
≥ 2 / 0.60 (0.54-0.67) / 0.69 (0.60-0.79)
Region
New England (ref) / 1.00 / 1.00
East North Central / 1.82 (1.62-2.05) / 2.46 (2.05-2.93)
East South Central / 1.64 (1.39-1.93) / 2.73 (2.20-3.40)
Middle Atlantic / 1.86 (1.64-2.11) / 2.66 (2.21-3.20)
Mountain / 1.98 (1.66-2.35) / 2.16 (1.69-2.76)
Pacific / 2.0 (1.75-2.29) / 2.42 (2.00-2.94)
South Atlantic / 2.06 (1.83-2.32) / 2.77 (2.32-3.31)
West North Central / 2.73 (2.33-3.19) / 3.26 (2.63-4.05)
West South Central / 2.61 (2.21-3.09) / 4.62 (3.71-5.75)
Facility
NCI/teaching/research center (ref) / 1.00 / 1.00
Community cancer center / 1.42 (1.24-1.63) / 1.74 (1.47-2.05)
Comprehensive community cancer center / 1.21 (1.12-1.30) / 1.24 (1.13-1.37)
Other programs / 1.25 (1.10-1.43) / 1.08 (0.91-1.28)
Case volume
High (ref) / 1.00 / 1.00
Low / 0.78 (0.68-0.88) / 1.17(1.0-1.37)
Medium / 0.94 (0.87-1.02) / 1.23 (1.12-1.36)
Insurance
Private (ref) / 1.00 / 1.00
Uninsured / 0.744 (0.45-1.23) / 0.72(0.40-1.31)
Medicaid / 0.65 (0.50-0.85) / 0.66 (0.47-0.91)
Medicare / 0.82 (0.75-0.91) / 0.72 (0.64-0.82)
Other/missing / 0.73 (0.55-0.96) / 0.97(0.70-1.34)
Median income
≥ 46,000 (ref) / 1.00 / 1.00
<30,000 / 1.04 (0.93-1.17) / 1.29 (1.13-1.49)
30,000-34,999 / 1.12 (1.02-1.23) / 1.24 (1.10-1.39)
35,000-45,999 / 1.07 (0.99-1.15) / 1.17 (1.06-1.28)
Missing / 1.18 (0.97-1.43) / 1.26 (0.99-1.61)
Neoadjuvant chemotherapy
No (ref) / 1.00 / 1.00
Yes / 0.93 (0.69-1.24) / 0.86 (0.62-1.18)
Neoadjuvant hormonal therapy
No (ref) / 1.00 / 1.00
Yes / 0.45 (0.37-0.54) / 0.55 (0.44-0.70)
Surgery type
BCS (ref) / 1.00 / 1.00
Mastectomy, no reconstruction / 2.53 (2.31-2.77) / 10.90 (9.83-12.08)
Mastectomy and reconstruction / 2.32 (1.79-2.99) / 6.88 (5.26-9.01)

*Adjusted for all listed variables

Abbreviations: ALND, axillary lymph node dissection; BCS, breast conserving surgery; CI, confidence interval; ER, estrogen receptor; HER2, human epidermal growth factor receptor 2; NH, non-Hispanic; OR, odds ratio; PR, progesterone receptor; ref, reference; SLNB, sentinel lymph node biopsy