Objectives: Care guidelines recommend specific treatment pathways for early-stage breast cancer, but real-world adherence may vary due to institutional workflow and system-level limitations. This study examined rates of guideline-concordant care (GCC) at a single academic medical center over 5 years and evaluated differences by stage, patient demographics and time frame involving the COVID-19 pandemic.
Methods: A retrospective review was performed of all women diagnosed with American Joint Committee on Cancer (AJCC) Stage 0-III breast cancer at a National Cancer Institute-designated cancer center between September 1, 2019, and September 1, 2024. GCC was defined according to National Comprehensive Cancer Network (NCCN) guidelines as mastectomy alone, lumpectomy with radiation, or lumpectomy alone in patients ≥70. Demographic and clinical data were extracted, and rates of GCC were assessed by stage, race, insurance type, and for variance during the COVID-19 pandemic.
Results: Among 1455 patients diagnosed with stage 0-III breast cancer, 981 (67.4%) received some form of treatment, and 515 (35.4%) received GCC. Stage II patients had the lowest rate of GCC (28.7%). Rates of GCC remained stable before and after April 2020, though total diagnoses declined. Black patients had the highest rate of GCC (52.1%), while Asian/Pacific Islander patients had the lowest (21.9%). No clear relationship was observed between insurance type or ZIP code-based income and GCC receipt.
Conclusions: Most patients diagnosed with breast cancer received treatment, but fewer than half met criteria for GCC. Differences in GCC rate by stage and race suggest both institutional and patient-level barriers to standard care. System improvements aimed at strengthening coordination between diagnosis and treatment may help increase adherence to guideline-based breast cancer care.
Keywords: breast cancer; diagnosis; guideline-concordant care; radiation; surgery; treatment.
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