(010) Cardiotoxic Cancer Treatment in Screen-Detected Versus Non-Screen-Detected Breast Cancer Patients: A Study Based on German Claims Data

Background: Breast cancer patients and survivors are at increased risk of fatal and non-fatal cardiovascular events. Even though the primary aim of breast cancer screening is to reduce breast cancer mortality, it may also lower the need for cardiotoxic cancer therapy due to less advanced stages among screen-detected patients.

Objectives: To describe the use of cardiotoxic treatment (such as anthracyclines, taxanes, and anti-HER2 drugs) among women with newly diagnosed breast cancer who received parenteral cancer treatment, stratified by mode of detection.

Methods: Using the German Pharmacoepidemiological Research Database (GePaRD, claims data from ~20% of the German population), we included 50-69-year-old patients with invasive, non-metastatic breast cancer diagnosed in 2010–2016 receiving parenteral cancer treatment. Patients were followed until 2017. We classified them into screen-detected (SD), interval detected (ID) and unscreened (NoScreen). Stratified by these groups, we described included patients regarding breast cancer characteristics at diagnosis and disease course during follow-up, and utilization of individual (cardiotoxic) cancer drugs and total dispensed dose during the initial treatment phase.

Results: We included 9,358 women (35% SD, 21% ID, 44% NoScreen). Screen-detected patients were least frequently triple negative (SD: 17%, ID/NoScreen: 21%–23%) and also least frequently experienced recurrence (SD: 16%, ID/NoScreen: 24%–28%). The difference in the proportion of patients treated with individual cancer drugs between SDs and ID/NoScreen was below 4%, with the exception of 5-fluorouracil (SD: 31%, ID/NoScreen: 24%–25%) and paclitaxel (SD: 44%, ID/NoScreen: 48%–50%). For other drugs including anthracyclines, taxanes and anti-HER2 drugs, there was no difference in total dispensed dose during initial treatment between groups.

Conclusions: With few exceptions, there were no differences in the treatment with cardiotoxic cancer drugs or in the cumulative dispensed dose of these drugs during initial treatment according to mode of detection in our study. Breast cancer characteristics and disease course were more favorable among screen-detected patients.