Table S1. Codes for Identifying Breast Cancer Events and Surgical Procedures

Supplementary Material:

Table S1. Codes for identifying breast cancer events and surgical procedures

Histology / Code identified in SEER
Ductal / ICD-O-3: M-8500, 8521
Lobular / ICD-O-3: M-8520
Mixed ductal/ lobular / ICD-O-3: M-8522-4
Othera / ICD-O-3: M-8480, 8211, 8010, 8140, 8201, 8255, 8401, 8510, 8000, 8022, 8031, 8032, 8033, 8035, 8050, 8141, 8260, 8310, 8323, 8513, 8540, 8560, 8570, 8571, 8572, 8573, 8574, 8575, 8980, 8982, 9020,
Excludedb / ICD-O-3: M-8501, 8502, 8503, 8504, 8507, 8508, 8230, 8525, 8541, 8543, 8012, 8013, 8041, 8070, 8074, 8200, 8251, 8490
First suspected breast disorder date / Diagnosis code identified in Medicare claims
Suspected breast disorder diagnosis codes / 174 Malignant neoplasm of female breast
217. Benign neoplasm of breast
233.0 Carcinoma in situ of breast
238.3 Neoplasm of uncertain behavior of breast
239.3 Neoplasms of unspecified nature breast
610.0 Solitary cyst of breast
610.1 Diffuse cystic mastopathy
610.2 Fibroadenosis of breast
610.3 Fibrosclerosis of breast
610.9 Benign mammary dysplasia, unspecified
611.0 Inflammatory disease of breast
611.1 Hypertrophy of breast
611.3 Fat necrosis of breast
611.8 Other specified disorders of breast
611.9 Unspecified breast disorder
611.71 Signs and symptoms in breast
611.72 Lump or mass in breast
611.79 Signs and symptoms in breast
793.80 Abnormal mammogram, unspecified
793.81 Mammographic microcalcification
793.89 Other (abnormal) findings on radiological examination of breast
V711 Observation for suspected malignant neoplasm
Surgical Procedure / Code identified in Medicare claims
Partial mastectomyc / ICD-9-CM: 85.21-85.23; HCPCS: 19160/2, 19301/2
Mastectomy / ICD-9-CM: 85.4X; HCPCS: 19180, 19182, 19200, 19220, 19240, 19303-7

SEER, Surveillance, Epidemiology and End Results; HCPCS, Healthcare Common Procedure Classification System; ICD-9-CM, International Classification of Diseases, 9th Revision, Clinical Modification.

a Note: Two-thirds of “other histology” were mucinous or tubular adenocarcinomas

b Excluded do to pre-malignant (in situ) or non-malignant lesions histologies indicating non-breast initial tumors

c Breast excision codes of ICD-9-CM: 85.20; HCPCS: 19120, 19125, 19126, 19300 were not considered to be partial mastectomy

Table S2. SEER-Medicare inclusion/ exclusion criteria

Inclusion Criteria / Included / Excluded
Breast cancer diagnosis in SEER / 260,079
Diagnosed between 2003 and 2007 (inclusive) / 143,757 / 116,322
First or primary cancer / 131,974 / 11,783
Age 66 or older at diagnosis / 86,127 / 45,847
Female / 85,367 / 760
Reporting source not autopsy or death certificate / 84,466 / 901
Laterality is not bilateral or unknown / 83,659 / 807
Original reason for Medicare entitlement not disability or ESRD / 79,355 / 4,304
Has valid month of diagnosis / 79,114 / 241
Has no HMO enrollment during study perioda / 56,652 / 22,462
Has continuous enrollment in Part A&B during the study period / 52,038 / 4,614
Has comorbidity score and was able to be matched to claims during the study period / 47,108 / 4,930
Diagnosed between 2004 and 2007b / 38,645 / 8,463
Known Stage I-IIIA disease, tumor size <5cm, histologic codes indicating malignant breast cancer / 26,815 / 11,830
Histologic codes indicating malignant breast cancer / 26,456 / 359
Definitive surgery of either a partial mastectomy or mastectomy / 24,335 / 2,121
No prior cancer treatments before first definitive surgery / 23,816 / 519
Able to determine the type of surgery (i.e. partial mastectomy vs. mastectomy / 23,036 / 780
Patients with linkable to their surgical provider / 22,670 / 366
Had their first surgery within 4 months of their SEER diagnosis month / 22,226 / 444
Did not have a second primary cancer identified in SEER within 12 months of diagnosis / 20,332 / 1,894

ESRD, end stage renal disease; HMO, Health Maintenance Organization; SEER, Surveillance, Epidemiology and End Results

a Study period is 12 months prior to diagnosis month until the end of data or death

b We excluded patients diagnosed in 2003 because few patients (n=148) had a breast MRI and were unable to be balanced using propensity scores.

/ All Patients (n=20,332) / Patients with IDC (n=14,357) / Patients with ILC (n=1,914) / Patients with IDLC(n=2,380)
Histology
Ductal / (ref)
Lobular / 2.32*** [2.02, 2.67]
Mixed ductal/lobular / 1.47*** [1.29, 1.68]
Other / 0.83 [0.68, 1.02]
Tumor size
≤ 2cm / (ref) / (ref) / (ref) / (ref)
2cm, ≤ 5cm / 0.95 [0.85, 1.07] / 0.87 [0.75, 1.02] / 1.11 [0.84, 1.47] / 1.10 [0.83, 1.46]
Tumor grade
Well differentiated / (ref) / (ref) / (ref) / (ref)
Moderately differentiated / 1.01 [0.90, 1.13] / 1.02 [0.89, 1.18] / 0.99 [0.72, 1.35] / 1.04 [0.78, 1.39]
Poorly differentiated / 0.87 [0.75, 1.01] / 0.89 [0.74, 1.05] / 0.75 [0.45, 1.23] / 1.09 [0.73, 1.62]
Grade unknown / 0.84 [0.66, 1.06] / 1.13 [0.78, 1.66] / 0.85 [0.57, 1.28] / 0.44* [0.20, 0.96]
Hormone receptor status
Positive / (ref) / (ref) / (ref) / (ref)
Negative / 1.18* [1.01, 1.37] / 1.17 [0.99, 1.39] / 1.18 [0.61, 2.28] / 0.76 [0.44, 1.32]
Unknown / 0.98 [0.82, 1.18] / 1.03 [0.83, 1.30] / 0.68 [0.41, 1.13] / 1.09 [0.66, 1.80]
Node positivity / 1.11 [0.99, 1.25] / 1.15 [1.00, 1.33] / 0.98 [0.71, 1.35] / 1.11 [0.83, 1.49]
NCI Comorbidity Index
0 / (ref) / (ref) / (ref) / (ref)
Between 0 and 1 / 0.79*** [0.70, 0.88] / 0.81** [0.71, 0.93] / 0.77 [0.57, 1.04] / 0.59*** [0.44, 0.80]
Greater than 1 / 0.52*** [0.42, 0.66] / 0.53*** [0.40, 0.70] / 0.64 [0.33, 1.26] / 0.20*** [0.09, 0.48]
Age at diagnosis
65 to 69 / (ref) / (ref) / (ref) / (ref)
70 to 74 / 0.67*** [0.60, 0.75] / 0.66*** [0.57, 0.77] / 0.66* [0.46, 0.94] / 0.64** [0.47, 0.88]
75 to 79 / 0.46*** [0.40, 0.52] / 0.46*** [0.39, 0.54] / 0.44*** [0.30, 0.63] / 0.49*** [0.35, 0.69]
80 to 84 / 0.32*** [0.28, 0.37] / 0.33*** [0.28, 0.40] / 0.28*** [0.18, 0.42] / 0.36*** [0.24, 0.54]
85 and older / 0.16*** [0.13, 0.20] / 0.15*** [0.11, 0.20] / 0.12*** [0.06, 0.21] / 0.26*** [0.15, 0.45]
Married / 1.11* [1.01, 1.22] / 1.10 [0.98, 1.24] / 1.07 [0.82, 1.39] / 1.25 [0.98, 1.60]
State buy-in coverage
No / (ref) / (ref) / (ref) / (ref)
Yes / 0.60*** [0.49, 0.73] / 0.66*** [0.52, 0.84] / 0.41** [0.22, 0.76] / 0.53* [0.30, 0.92]
Race
White / (ref) / (ref) / (ref) / (ref)
Non-white / 0.93 [0.80, 1.08] / 0.86 [0.71, 1.03] / 1.07 [0.71, 1.61] / 1.08 [0.72, 1.62]
Cooperative group affiliation of surgical facility a / 1.33*** [1.20, 1.48] / 1.39*** [1.22, 1.58] / 1.57** [1.17, 2.08] / 1.07 [0.81, 1.41]
NCI affiliation of surgical facility / 1.18 [0.97, 1.44] / 1.28 [1.00, 1.63] / 1.52 [0.83, 2.77] / 0.83 [0.53, 1.30]
Surgical facility a teaching hospital (or affiliated one) / 0.90 [0.81, 1.01] / 0.87 [0.76, 1.00] / 0.97 [0.71, 1.31] / 0.97 [0.73, 1.28]
Surgical volume of facility
Low / (ref) / (ref) / (ref) / (ref)
High / 2.10*** [1.88, 2.34] / 2.08*** [1.81, 2.39] / 1.63*** [1.22, 2.18] / 2.76*** [2.03, 3.74]
Zip code proportion with at
least a high school education
Low education / (ref) / (ref) / (ref) / (ref)
Low-medium education / 0.77*** [0.68, 0.86] / 0.76*** [0.65, 0.88] / 0.72 [0.51, 1.01] / 0.85 [0.61, 1.17]
Medium-high education / 0.71*** [0.62, 0.81] / 0.75*** [0.63, 0.88] / 0.53*** [0.36, 0.77] / 0.76 [0.53, 1.09]
High education / 0.50*** [0.42, 0.59] / 0.49*** [0.40, 0.61] / 0.38*** [0.24, 0.60] / 0.68 [0.43, 1.06]
Unknown education / 0.71** [0.56, 0.91] / 0.75 [0.56, 1.01] / 0.48* [0.25, 0.92] / 0.77 [0.39, 1.52]
Year of diagnosis
2004 / (ref) / (ref) / (ref) / (ref)
2005 / 1.64*** [1.39, 1.92] / 1.61*** [1.30, 1.98] / 2.09*** [1.36, 3.21] / 1.51* [1.03, 2.23]
2006 / 2.76*** [2.38, 3.21] / 2.98*** [2.46, 3.61] / 3.42*** [2.26, 5.18] / 2.19*** [1.52, 3.16]
2007 / 5.09*** [4.40, 5.88] / 5.21*** [4.34, 6.26] / 5.36*** [3.59, 8.01] / 5.03*** [3.51, 7.20]
SEER Region
California registries / (ref) / (ref) / (ref) / (ref)
Northeast registries / 1.08 [0.94, 1.24] / 1.08 [0.91, 1.29] / 0.88 [0.61, 1.28] / 1.05 [0.73, 1.51]
Georgia / 0.55*** [0.42, 0.71] / 0.51*** [0.37, 0.71] / 0.49 [0.23, 1.06] / 0.83 [0.42, 1.63]
Detroit / 0.60*** [0.48, 0.75] / 0.65** [0.49, 0.86] / 0.53* [0.30, 0.94] / 0.47* [0.25, 0.85]
Iowa / 0.42*** [0.31, 0.55] / 0.50*** [0.36, 0.70] / 0.21*** [0.10, 0.46] / 0.30** [0.13, 0.71]
New Mexico / 3.39*** [2.65, 4.33] / 3.13*** [2.28, 4.30] / 3.17** [1.57, 6.39] / 4.14*** [2.22, 7.72]
Seattle / 1.87*** [1.57, 2.24] / 1.75*** [1.40, 2.18] / 3.20*** [1.97, 5.22] / 1.47 [0.88, 2.46]
Utah / 0.67** [0.50, 0.90] / 0.82 [0.58, 1.14] / 0.47 [0.17, 1.30] / 0.22* [0.06, 0.78]
Kentucky / 0.29*** [0.22, 0.39] / 0.31*** [0.22, 0.44] / 0.25*** [0.11, 0.57] / 0.18*** [0.07, 0.44]
Louisiana / 0.36*** [0.27, 0.49] / 0.45*** [0.32, 0.63] / 0.23*** [0.10, 0.54] / 0.12** [0.03, 0.53]
Hawaiib / 0.14*** [0.05, 0.35] / 0.15*** [0.05, 0.43]

* p<0.05, ** p<0.01, *** p<0.001"

MRI, Magnetic Resonance Imaging; IDC, invasive ductal carcinoma; ILC, invasive lobular carcinoma; IDLC, mixed invasive ductal/lobular carcinoma; SEER, Surveillance, Epidemiology and End Results; NCI, National Cancer Institute.

a NCI Cooperative Groups having breast cancer research portfolios

bNo patients from the Hawaii SEER region with ILC or IDLChad an MRI, thus these patients had a zero propensity for breast MRI and were excluded in those subgroup analyses.

/ All Patients (n=20,332) / Patients with IDC (n=14,357) / Patients with ILC (n=1,928) / Patients with IDLC(n=2,398)
Preoperative breast MRI / 1.33*** [1.20, 1.49] / 1.24** [1.08, 1.42] / 1.41* [1.07, 1.86] / 1.86*** [1.42, 2.45]
Histology
Ductal / (ref)
Lobular / 1.24*** [1.11, 1.39]
Mixed ductal/lobular / 1.08 [0.97, 1.20]
Other / 0.89 [0.78, 1.01]
Tumor size
≤ 2cm / (ref) / (ref) / (ref) / (ref)
2cm, ≤ 5cm / 2.29*** [2.13, 2.46] / 2.23*** [2.04, 2.44] / 2.84*** [2.30, 3.52] / 2.02*** [1.64, 2.48]
Tumor grade
Well differentiated / (ref) / (ref) / (ref) / (ref)
Moderately differentiated / 1.06 [0.98, 1.16] / 1.05 [0.95, 1.17] / 1.18 [0.91, 1.53] / 1.18 [0.93, 1.49]
Poorly differentiated / 1.17** [1.06, 1.30] / 1.23*** [1.09, 1.38] / 1.06 [0.71, 1.59] / 1.01 [0.74, 1.38]
Grade unknown / 1.22* [1.05, 1.43] / 1.16 [0.89, 1.51] / 1.40* [1.02, 1.92] / 1.77* [1.12, 2.78]
Hormone receptor status
Positive / (ref) / (ref) / (ref) / (ref)
Negative / 1.27*** [1.15, 1.41] / 1.26*** [1.13, 1.41] / 2.03* [1.18, 3.50] / 1.25 [0.84, 1.84]
Unknown / 1.47*** [1.31, 1.65] / 1.53*** [1.34, 1.76] / 1.40 [0.97, 2.00] / 1.38 [0.95, 2.02]
Node positivity / 1.85*** [1.72, 2.00] / 1.87*** [1.71, 2.05] / 1.88*** [1.47, 2.40] / 1.80*** [1.44, 2.25]
NCI Comorbidity Index
0 / (ref) / (ref) / (ref) / (ref)
Between 0 and 1 / 1.13** [1.05, 1.21] / 1.08 [0.99, 1.18] / 1.15 [0.91, 1.46] / 1.35** [1.09, 1.68]
Greater than 1 / 1.32*** [1.18, 1.49] / 1.38*** [1.20, 1.58] / 1.10 [0.75, 1.61] / 1.82*** [1.28, 2.59]
Age at diagnosis
65 to 69 / (ref) / (ref) / (ref) / (ref)
70 to 74 / 1.17** [1.05, 1.29] / 1.15* [1.03, 1.30] / 0.91 [0.65, 1.27] / 1.21 [0.90, 1.62]
75 to 79 / 1.39*** [1.26, 1.54] / 1.39*** [1.23, 1.56] / 1.36 [0.98, 1.89] / 1.24 [0.92, 1.66]
80 to 84 / 1.69*** [1.52, 1.89] / 1.68*** [1.49, 1.91] / 1.57* [1.11, 2.22] / 1.44* [1.05, 1.98]
85 and older / 1.63*** [1.44, 1.84] / 1.59*** [1.37, 1.85] / 1.59* [1.08, 2.34] / 1.70** [1.18, 2.46]
Married / 0.92* [0.86, 0.99] / 0.91* [0.84, 0.99] / 1.08 [0.87, 1.34] / 0.84 [0.69, 1.04]
State buy-in coverage
No / (ref) / (ref) / (ref) / (ref)
Yes / 1.33*** [1.19, 1.48] / 1.32*** [1.16, 1.50] / 1.49* [1.00, 2.21] / 1.25 [0.91, 1.73]
Race
White / (ref) / (ref) / (ref) / (ref)
Non-white / 1.31*** [1.18, 1.45] / 1.36*** [1.20, 1.54] / 1.04 [0.71, 1.52] / 1.41* [1.03, 1.94]
Cooperative group affiliation of surgical facility a / 1.00 [0.93, 1.07] / 0.97 [0.89, 1.06] / 1.07 [0.85, 1.35] / 1.06 [0.86, 1.31]
NCI affiliation of surgical facility / 0.73*** [0.62, 0.87] / 0.70** [0.57, 0.87] / 1.00 [0.61, 1.65] / 0.79 [0.52, 1.21]
Surgical facility a teaching hospital (or affiliated one) / 0.91** [0.84, 0.98] / 0.94 [0.86, 1.03] / 0.84 [0.66, 1.06] / 0.74** [0.59, 0.92]
Surgical volume of facility
Low / (ref) / (ref) / (ref) / (ref)
High / 0.73*** [0.68, 0.78] / 0.73*** [0.67, 0.79] / 0.74** [0.59, 0.93] / 0.64*** [0.52, 0.80]
Zip code proportion with at
least a high school education
Low education / (ref) / (ref) / (ref) / (ref)
Low-medium education / 1.18*** [1.07, 1.30] / 1.23*** [1.09, 1.38] / 1.02 [0.75, 1.38] / 0.99 [0.75, 1.31]
Medium-high education / 1.37*** [1.23, 1.52] / 1.42*** [1.25, 1.61] / 1.67** [1.21, 2.31] / 0.97 [0.71, 1.31]
High education / 1.53*** [1.36, 1.72] / 1.67*** [1.45, 1.92] / 1.33 [0.92, 1.91] / 1.29 [0.91, 1.83]
Unknown education / 1.51*** [1.28, 1.80] / 1.52*** [1.24, 1.87] / 1.13 [0.64, 2.00] / 1.48 [0.91, 2.39]
Year of diagnosis
2004 / (ref) / (ref) / (ref) / (ref)
2005 / 1.21*** [1.11, 1.33] / 1.24*** [1.11, 1.39] / 0.99 [0.73, 1.33] / 1.24 [0.95, 1.62]
2006 / 1.00 [0.91, 1.10] / 0.97 [0.87, 1.08] / 0.92 [0.68, 1.23] / 1.06 [0.81, 1.38]
2007 / 1.08 [0.98, 1.18] / 1.13* [1.01, 1.26] / 0.99 [0.73, 1.33] / 0.88 [0.67, 1.16]
SEER Region
California registries / (ref) / (ref) / (ref) / (ref)
Northeast registries / 0.67*** [0.60, 0.75] / 0.68*** [0.60, 0.78] / 0.64* [0.46, 0.90] / 0.68* [0.50, 0.92]
Georgia / 1.35** [1.12, 1.63] / 1.29* [1.04, 1.61] / 1.83* [1.04, 3.24] / 1.19 [0.67, 2.12]
Detroit / 1.01 [0.87, 1.18] / 0.97 [0.80, 1.17] / 1.02 [0.64, 1.63] / 0.95 [0.60, 1.52]
Iowa / 2.37*** [2.04, 2.75] / 2.39*** [2.00, 2.86] / 2.55*** [1.59, 4.10] / 2.09** [1.30, 3.36]
New Mexico / 1.15 [0.91, 1.44] / 1.27 [0.97, 1.66] / 0.99 [0.48, 2.02] / 0.63 [0.29, 1.37]
Seattle / 1.10 [0.95, 1.27] / 1.06 [0.89, 1.27] / 0.87 [0.54, 1.39] / 1.57* [1.02, 2.42]
Utah / 1.36** [1.12, 1.66] / 1.42** [1.12, 1.80] / 1.65 [0.80, 3.37] / 1.37 [0.78, 2.43]
Kentucky / 2.14*** [1.86, 2.46] / 2.25*** [1.90, 2.66] / 1.78* [1.12, 2.85] / 1.61* [1.01, 2.57]
Louisiana / 1.98*** [1.73, 2.28] / 1.85*** [1.57, 2.18] / 1.97** [1.26, 3.07] / 2.01** [1.27, 3.17]
Hawaii / 0.76 [0.55, 1.06] / 0.69 [0.47, 1.01] / 0.64 [0.19, 2.18] / 0.61 [0.19, 1.89]
AIC / 22217.1 / 15594.2 / 2287.9 / 2653.2

* p<0.05, ** p<0.01, *** p<0.001"

MRI, Magnetic Resonance Imaging; ; IDC, invasive ductal carcinoma; ILC, invasive lobular carcinoma; IDLC, mixed invasive ductal/lobular carcinoma; SEER, Surveillance, Epidemiology and End Results; NCI, National Cancer Institute; AIC, Akaike information criterion

a NCI Cooperative Groups having breast cancer research portfolios

/ All Patients (n=14,210) / Patients with IDC (n=10,051) / Patients with ILC (n=1,253) / Patients with IDLC
(n=1,710)
Preoperative breast MRI / 0.97 [0.85, 1.11] / 1.01 [0.86, 1.20] / 0.69* [0.48, 0.99] / 0.94 [0.68, 1.30]
Histology
Ductal / (ref.)
Lobular / 1.62*** [1.41, 1.87]
Mixed ductal/lobular / 1.44*** [1.28, 1.63]
Other / 0.98 [0.83, 1.15]
Tumor size
≤ 2cm / (ref.) / (ref.) / (ref.) / (ref.)
2cm, ≤ 5cm / 1.27*** [1.14, 1.40] / 1.05 [0.92, 1.20] / 2.33*** [1.75, 3.11] / 1.61*** [1.25, 2.08]
Tumor grade
Well differentiated / (ref.) / (ref.) / (ref.) / (ref.)
Moderately differentiated / 1.19** [1.07, 1.32] / 1.28*** [1.12, 1.46] / 1.38 [0.99, 1.92] / 0.99 [0.75, 1.29]
Poorly differentiated / 1.20** [1.05, 1.37] / 1.34*** [1.14, 1.57] / 0.84 [0.48, 1.47] / 1.10 [0.77, 1.57]
Grade unknown / 1.64*** [1.36, 2.00] / 2.28*** [1.68, 3.08] / 1.60* [1.07, 2.40] / 1.46 [0.85, 2.50]
Hormone receptor status
Positive / (ref.) / (ref.) / (ref.) / (ref.)
Negative / 1.07 [0.93, 1.23] / 1.02 [0.87, 1.19] / 1.26 [0.58, 2.77] / 1.58 [1.00, 2.49]
Unknown / 1.11 [0.94, 1.30] / 1.12 [0.92, 1.37] / 1.54 [0.97, 2.45] / 0.97 [0.62, 1.52]
Node positivity / 1.58*** [1.42, 1.75] / 1.64*** [1.45, 1.86] / 1.34 [0.96, 1.85] / 1.44* [1.08, 1.92]
NCI Comorbidity Index
0 / (ref.) / (ref.) / (ref.) / (ref.)
Between 0 and 1 / 1.04 [0.95, 1.15] / 1.03 [0.91, 1.15] / 0.77 [0.56, 1.07] / 1.23 [0.95, 1.60]
Greater than 1 / 1.25** [1.06, 1.47] / 1.32** [1.09, 1.59] / 1.07 [0.62, 1.83] / 1.07 [0.64, 1.79]
Age at diagnosis
65 to 69 / (ref.) / (ref.) / (ref.) / (ref.)
70 to 74 / 0.92 [0.82, 1.03] / 0.91 [0.79, 1.05] / 0.75 [0.52, 1.08] / 1.04 [0.76, 1.43]
75 to 79 / 0.84** [0.74, 0.95] / 0.90 [0.78, 1.04] / 0.57** [0.38, 0.85] / 0.80 [0.58, 1.12]
80 to 84 / 0.77*** [0.68, 0.89] / 0.84* [0.71, 0.99] / 0.53** [0.35, 0.81] / 0.63* [0.43, 0.92]
85 and older / 0.57*** [0.48, 0.68] / 0.56*** [0.45, 0.69] / 0.42** [0.25, 0.71] / 0.76 [0.48, 1.20]
Married / 1.02 [0.94, 1.12] / 1.03 [0.93, 1.15] / 1.30 [0.99, 1.71] / 0.84 [0.67, 1.07]
State buy-in coverage
No / (ref.) / (ref.) / (ref.) / (ref.)
Yes / 1.08 [0.92, 1.26] / 1.12 [0.92, 1.35] / 1.40 [0.84, 2.34] / 1.14 [0.76, 1.70]
Race
White / (ref.) / (ref.) / (ref.) / (ref.)
Non-white
Cooperative group affiliation of surgical facility a / 1.02 [0.89, 1.17] / 1.02 [0.86, 1.20] / 1.12 [0.72, 1.75] / 0.99 [0.68, 1.45]
NCI affiliation of surgical facility / 0.96 [0.87, 1.05] / 0.95 [0.84, 1.06] / 1.07 [0.80, 1.45] / 0.96 [0.74, 1.23]
Surgical facility a teaching hospital (or affiliated one) / 1.22* [1.03, 1.46] / 1.22 [0.98, 1.52] / 1.59 [0.85, 2.97] / 1.12 [0.75, 1.67]
Surgical volume of facility
Low / (ref.) / (ref.) / (ref.) / (ref.)
High / 1.03 [0.94, 1.12] / 0.98 [0.88, 1.09] / 1.22 [0.91, 1.64] / 1.21 [0.94, 1.57]
Zip code proportion with at
least a high school education
Low education / (ref.) / (ref.) / (ref.) / (ref.)
Low-medium education / 0.92 [0.82, 1.03] / 0.93 [0.81, 1.07] / 0.75 [0.52, 1.08] / 1.00 [0.74, 1.36]
Medium-high education / 0.88* [0.78, 1.00] / 0.90 [0.77, 1.05] / 0.63* [0.42, 0.95] / 0.89 [0.63, 1.24]
High education / 0.91 [0.78, 1.05] / 0.89 [0.75, 1.06] / 0.76 [0.49, 1.16] / 0.90 [0.60, 1.34]
Unknown education / 0.86 [0.68, 1.09] / 1.05 [0.79, 1.38] / 0.36** [0.17, 0.77] / 0.65 [0.33, 1.28]
Year of diagnosis
2004 / (ref.) / (ref.) / (ref.) / (ref.)
2005 / 0.65*** [0.58, 0.74] / 0.62*** [0.54, 0.72] / 0.62* [0.42, 0.91] / 0.72* [0.53, 0.99]
2006 / 0.72*** [0.65, 0.81] / 0.73*** [0.64, 0.84] / 0.74 [0.51, 1.06] / 0.88 [0.66, 1.19]
2007 / 0.68*** [0.60, 0.76] / 0.67*** [0.58, 0.77] / 0.65* [0.45, 0.94] / 0.78 [0.57, 1.07]
SEER Region
California registries / (ref.) / (ref.) / (ref.) / (ref.)
Northeast registries / 1.22** [1.07, 1.39] / 1.39*** [1.19, 1.63] / 1.11 [0.75, 1.66] / 0.79 [0.57, 1.10]
Georgia / 1.11 [0.87, 1.42] / 1.16 [0.86, 1.56] / 0.83 [0.36, 1.91] / 1.34 [0.70, 2.58]
Detroit / 1.79*** [1.50, 2.14] / 2.02*** [1.63, 2.51] / 1.85* [1.06, 3.22] / 1.19 [0.74, 1.90]
Iowa / 0.82 [0.65, 1.04] / 0.93 [0.70, 1.24] / 0.63 [0.29, 1.36] / 0.68 [0.32, 1.43]
New Mexico / 1.51** [1.14, 2.00] / 1.53* [1.06, 2.19] / 2.64* [1.25, 5.59] / 1.17 [0.57, 2.43]
Seattle / 1.05 [0.86, 1.27] / 1.13 [0.89, 1.42] / 1.39 [0.78, 2.46] / 1.02 [0.58, 1.79]
Utah / 1.02 [0.77, 1.35] / 1.00 [0.70, 1.41] / 1.71 [0.52, 5.66] / 0.90 [0.43, 1.87]
Kentucky / 0.71** [0.57, 0.89] / 0.73* [0.56, 0.96] / 1.00 [0.52, 1.91] / 0.72 [0.40, 1.31]
Louisiana / 1.22 [1.00, 1.49] / 1.33* [1.05, 1.69] / 1.30 [0.68, 2.47] / 0.79 [0.41, 1.56]
Hawaii / 1.21 [0.84, 1.76] / 1.25 [0.81, 1.93] / 1.75 [0.42, 7.20] / 1.34 [0.43, 4.19]
AIC / 14054.8 / 9582.6 / 1448.4 / 1961.7

* p<0.05, ** p<0.01, *** p<0.001"

a NCI Cooperative Groups having breast cancer research portfolios

/ All Patients (n=20,332) / Patients with IDC (n=14,357) / Patients with ILC (n=1,928) / Patients with IDLC(n=2,398)
Preoperative breast MRI / 1.23*** [1.11, 1.37] / 1.24*** [1.09, 1.41] / 1.03 [0.78, 1.35] / 1.36* [1.05, 1.77]
Histology
Ductal / (ref)
Lobular / 1.45*** [1.30, 1.62]
Mixed ductal/lobular / 1.25*** [1.13, 1.38]
Other / 0.90 [0.80, 1.02]
Tumor size
≤ 2cm / (ref) / (ref) / (ref) / (ref)
2cm, ≤ 5cm / 2.24*** [2.09, 2.40] / 2.08*** [1.91, 2.27] / 3.36*** [2.72, 4.15] / 2.17*** [1.78, 2.65]
Tumor grade
Well differentiated / (ref) / (ref) / (ref) / (ref)
Moderately differentiated / 1.10* [1.02, 1.19] / 1.11* [1.00, 1.22] / 1.26 [0.98, 1.63] / 1.15 [0.92, 1.43]
Poorly differentiated / 1.24*** [1.13, 1.37] / 1.33*** [1.19, 1.50] / 1.00 [0.67, 1.49] / 1.11 [0.83, 1.49]
Grade unknown / 1.43*** [1.23, 1.66] / 1.51*** [1.18, 1.94] / 1.60** [1.18, 2.18] / 1.85** [1.21, 2.82]
Hormone receptor status
Positive / (ref) / (ref) / (ref) / (ref)
Negative / 1.28*** [1.16, 1.41] / 1.23*** [1.10, 1.37] / 2.46** [1.39, 4.33] / 1.41 [0.97, 2.05]
Unknown / 1.48*** [1.32, 1.66] / 1.52*** [1.33, 1.74] / 1.65** [1.16, 2.36] / 1.21 [0.85, 1.74]
Node positivity / 2.06*** [1.91, 2.22] / 2.06*** [1.89, 2.25] / 2.21*** [1.74, 2.83] / 2.03*** [1.64, 2.53]
NCI Comorbidity Index
0 / (ref) / (ref) / (ref) / (ref)
Between 0 and 1 / 1.14*** [1.06, 1.22] / 1.08 [1.00, 1.18] / 1.14 [0.90, 1.44] / 1.41** [1.15, 1.74]
Greater than 1 / 1.34*** [1.20, 1.50] / 1.42*** [1.24, 1.62] / 1.34 [0.92, 1.96] / 1.52* [1.08, 2.13]
Age at diagnosis
65 to 69 / (ref) / (ref) / (ref) / (ref)
70 to 74 / 1.15** [1.04, 1.26] / 1.13* [1.01, 1.27] / 0.92 [0.67, 1.27] / 1.21 [0.92, 1.59]
75 to 79 / 1.32*** [1.20, 1.45] / 1.34*** [1.19, 1.50] / 1.17 [0.85, 1.62] / 1.19 [0.91, 1.57]
80 to 84 / 1.55*** [1.40, 1.72] / 1.61*** [1.43, 1.82] / 1.29 [0.92, 1.81] / 1.15 [0.85, 1.55]
85 and older / 1.46*** [1.30, 1.65] / 1.45*** [1.25, 1.67] / 1.26 [0.86, 1.85] / 1.64** [1.15, 2.32]
Married / 0.94 [0.88, 1.01] / 0.92* [0.85, 1.00] / 1.30* [1.06, 1.61] / 0.82* [0.68, 1.00]
State buy-in coverage
No / (ref) / (ref) / (ref) / (ref)
Yes / 1.35*** [1.22, 1.50] / 1.39*** [1.22, 1.57] / 1.40 [0.95, 2.07] / 1.19 [0.88, 1.63]
Race
White / (ref) / (ref) / (ref) / (ref)
Non-white / 1.33*** [1.20, 1.47] / 1.36*** [1.21, 1.53] / 1.16 [0.80, 1.68] / 1.37* [1.01, 1.87]
Cooperative group affiliation of surgical facility a / 0.99 [0.92, 1.06] / 0.97 [0.89, 1.06] / 1.04 [0.83, 1.31] / 1.01 [0.82, 1.23]
NCI affiliation of surgical facility / 0.79** [0.68, 0.93] / 0.79* [0.65, 0.96] / 0.94 [0.58, 1.54] / 0.85 [0.58, 1.25]
Surgical facility a teaching hospital (or affiliated one) / 0.90** [0.84, 0.97] / 0.92* [0.84, 1.00] / 0.90 [0.72, 1.14] / 0.77* [0.63, 0.95]
Surgical volume of facility
Low / (ref) / (ref) / (ref) / (ref)
High / 0.73*** [0.68, 0.78] / 0.70*** [0.64, 0.76] / 0.85 [0.68, 1.07] / 0.72** [0.59, 0.88]
Zip code proportion with at
least a high school education
Low education / (ref) / (ref) / (ref) / (ref)
Low-medium education / 1.17*** [1.07, 1.28] / 1.21*** [1.08, 1.35] / 1.00 [0.75, 1.33] / 1.03 [0.80, 1.33]
Medium-high education / 1.33*** [1.20, 1.47] / 1.40*** [1.24, 1.57] / 1.39* [1.02, 1.90] / 1.03 [0.78, 1.37]
High education / 1.48*** [1.33, 1.66] / 1.60*** [1.40, 1.83] / 1.27 [0.89, 1.80] / 1.34 [0.97, 1.85]
Unknown education / 1.35*** [1.15, 1.60] / 1.40** [1.14, 1.71] / 0.78 [0.44, 1.39] / 1.49 [0.93, 2.37]
Year of diagnosis
2004 / (ref) / (ref) / (ref) / (ref)
2005 / 1.01 [0.93, 1.11] / 1.04 [0.94, 1.16] / 0.73* [0.55, 0.98] / 1.02 [0.79, 1.30]
2006 / 0.85*** [0.78, 0.93] / 0.85** [0.77, 0.95] / 0.67** [0.50, 0.88] / 0.91 [0.71, 1.17]
2007 / 0.89* [0.82, 0.97] / 0.95 [0.86, 1.06] / 0.78 [0.59, 1.04] / 0.69** [0.53, 0.90]
SEER Region
California registries / (ref) / (ref) / (ref) / (ref)
Northeast registries / 0.75*** [0.68, 0.83] / 0.79*** [0.69, 0.89] / 0.64** [0.46, 0.89] / 0.67** [0.51, 0.89]
Georgia / 1.29** [1.07, 1.54] / 1.24 [1.00, 1.54] / 1.52 [0.86, 2.71] / 1.50 [0.86, 2.60]
Detroit / 1.12 [0.96, 1.29] / 1.08 [0.90, 1.29] / 1.11 [0.71, 1.73] / 1.10 [0.73, 1.66]
Iowa / 2.22*** [1.92, 2.58] / 2.33*** [1.96, 2.78] / 2.15** [1.34, 3.47] / 1.58 [1.00, 2.51]
New Mexico / 1.24 [0.99, 1.54] / 1.37* [1.06, 1.78] / 1.06 [0.55, 2.02] / 0.88 [0.45, 1.75]
Seattle / 1.08 [0.94, 1.25] / 1.04 [0.88, 1.23] / 0.97 [0.62, 1.51] / 1.57* [1.05, 2.37]
Utah / 1.40*** [1.15, 1.69] / 1.46*** [1.17, 1.83] / 1.49 [0.70, 3.17] / 1.35 [0.77, 2.38]
Kentucky / 2.01*** [1.75, 2.30] / 2.14*** [1.82, 2.52] / 1.66* [1.04, 2.65] / 1.51 [0.97, 2.34]
Louisiana / 2.02*** [1.77, 2.32] / 1.92*** [1.64, 2.26] / 1.72* [1.10, 2.70] / 1.91** [1.22, 2.99]
Hawaii / 0.79 [0.58, 1.07] / 0.66* [0.46, 0.95] / 0.99 [0.32, 3.10] / 1.06 [0.36, 3.10]
AIC / 23652.4 / 16541.1 / 2379.0 / 2897.1

* p<0.05, ** p<0.01, *** p<0.001"

a NCI Cooperative Groups having breast cancer research portfolios