Survival among Breast Cancer Patients: Comparison of the U.S. Military Health System with the Surveillance, Epidemiology and End Results Program

Jie Lin; Hai Hu; Craig D Shriver; Kangmin Zhu

doi:10.1016/j.clbc.2021.11.010

Survival among Breast Cancer Patients: Comparison of the U.S. Military Health System with the Surveillance, Epidemiology and End Results Program

Clin Breast Cancer. 2022 Jun;22(4):e506-e516. doi: 10.1016/j.clbc.2021.11.010. Epub 2021 Dec 1.

Authors

Jie Lin¹, Hai Hu², Craig D Shriver³, Kangmin Zhu⁴

Affiliations

¹ John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD; Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD. Electronic address: jie.lin.ctr@usuhs.edu.
² Chan Soon-Shiong Institute of Molecular Medicine at Windber, Windber, PA.
³ John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD.
⁴ John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD; Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD. Electronic address: kangmin.zhu@usuhs.edu.

PMID: 34961733
DOI: 10.1016/j.clbc.2021.11.010

Abstract

Introduction: Accessibility to health care is important to cancer survival. The U.S. military health system (MHS) provides universal health care access. However, whether the universal care has been translated into improved cancer survival is unknown. We compared survival of patients with breast cancer in the MHS with that in the U.S. general population and assessed the differences in cancer stage at diagnosis and treatment receipt between the two populations.

Methods: The MHS patients (n = 31,548) were identified from the Department of Defense's (DoD) Automated Central Tumor Registry (ACTUR). Patients in the U.S. general population (n = 63,096) were identified from the Surveillance, Epidemiology, and End Results (SEER) program. The two populations were matched on age, race, and diagnosis year. Multivariable Cox regression hazard modeling was used to estimate hazard ratios (HRs) comparing ACTUR with SEER. Multivariable logistic regression was used to estimate odds ratios (ORs) comparing stage and treatment receipt.

Results: ACTUR patients exhibited a 24% lower overall mortality than the SEER patients (HR = 0.76, 95% CI, 0.71-0.80). They were less likely to present with later stage compared to the SEER patients (OR = 0.61, 95% CI, 0.55-0.67 for stage IV tumors). The ACTUR patients with stages I-III tumors were more likely to receive surgery (OR = 1.35, 95% CI, 1.20-1.52) but less likely to receive radiation (OR = 0.91, 95% CI, 0.88-0.94). The survival advantage of ACTUR patients remained regardless of surgery or radiation receipt.

Conclusions: Breast cancer patients with universal health care access had improved survival compared to patients in the general population.

Keywords: Breast cancer; SEER; Survival; Universal healthcare.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Breast Neoplasms* / epidemiology
Breast Neoplasms* / therapy
Female
Humans
Military Health Services*
Neoplasm Staging
Proportional Hazards Models
SEER Program
United States / epidemiology