Data Show Guideline-Concordant Care Gaps in Inflammatory Breast Cancer

"These findings suggest that timely GCC receipt can improve OS among patients with IBC and may help to mitigate racial and ethnic disparities in OS among patients with IBC," according to the study authors.

Although receipt of guideline-concordant care (GCC) correlated with improved overall survival (OS) among those with nonmetastatic inflammatory breast cancer (IBC), most patients do not appear to receive all available types of GCC they are eligible for, according to findings from a cohort study published in JAMA Network Open.¹

Of 6945 patients included in the analysis, 1740 (25.1%) received GCC compared with 5205 (74.9%) who did not. Additionally, the rate of GCC use decreased from 32% in 2010 to 19% in 2017. Data showed that 91.3% of patients received neoadjuvant systemic therapy (NST) within 60 days of diagnosis, 51.3% had modified radical mastectomy without immediate reconstruction, and 63.3% received adequate radiotherapy following mastectomy.

Although the probability of receiving GCC did not significantly differ across racial and ethnic populations overall, investigators noted modality-specific disparities. Compared with patients who are White, initiation of NST within 60 days of diagnosis was less likely for those who are Asian (OR, 0.48; 95% CI, 0.27-0.84), Black (OR, 0.53; 95% CI, 0.41-0.68), or Hispanic (OR, 0.40; 95% CI, 0.29-0.55). A total of 36.7% of patients had radiotherapy omitted or administered before surgery; being Black or 70 years or older and having treatment from 2014 to 2018 and triple-negative disease correlated with a reduced probability of receiving properly sequenced radiotherapy.

The unadjusted 5-year OS rate was 63.9% (95% CI, 61.6%-66.3%) in patients who received GCC vs 55.9% (95% CI, 54.6%-57.4%) in those who did not receive GCC. The 5-year OS rate was 47.9% and 60.0% in patients who are Black and White, respectively; these rates were 28.8% vs 37.4% among those with triple-negative breast cancer and no receipt of GCC. Survival outcomes did not differ between different racial and ethnic populations who received GCC.

Treatment with GCC typically correlated with improved adjusted OS per multivariate analysis (HR, 0.75; 95% CI, 0.68-0.84; P <.001). Factors that independently correlated with worse adjusted OS included Black compared with White race (HR, 1.41; 95% CI, 1.26-1.58; P <.001), triple-negative disease vs hormone receptor (HR)–positive and HER2-negative disease (HR, 1.61; 95% CI, 1.44-1.80; P <.001), and being 70 years and older (HR, 2.04; 95% CI, 1.71-2.44; P <.001).

“In this cohort study of women with nonmetastatic IBC, GCC was associated with greater OS. However, most patients with IBC do not appear to receive GCC and the rates of GCC have decreased in more recent years,” lead study author Audree Tadros, MD, MPH, FACS, breast surgeon and Jeanne A. Petrek Junior Faculty Chair at Memorial Sloan Kettering Cancer Center, wrote with coauthors.¹ “While OS for IBC was lowest among Black women, there was no racial and ethnic disparity among GCC recipients with triple-negative disease. These findings suggest that timely GCC receipt can improve OS among patients with IBC and may help to mitigate racial and ethnic disparities in OS among patients with IBC.”

Investigators of this retrospective cohort study assessed data collected from the National Cancer Database on patients with nonmetastatic IBC who underwent treatment from 2010 to 2018. The study included patients regardless of their treatment to capture all populations who did and did not receive GCC.

The study’s main objectives were determining how patient-, disease-, treatment-, and facility-level factors correlated with receipt of overall and modality-specific GCC as well as adjusted OS.

Among 6726 patients who had available data on their race and ethnicity, most were White (71.5%) followed by Black (17.1%), Hispanic (7.8%), Asian or Pacific Islander (2.4%), or other races (1.2%). Additionally, most of the overall population had private or managed care insurance (50.7%), residence in a metropolitan area (82.9%), stage III tumors (66.7%), and HR-positive and HER2-negative disease (36.5%).

“More information is needed to understand what physicians and patients perceive as [GCC] and why it is or is not received, since it is associated with improved survival. Deviation from [GCC] is not evidence-based and should be avoided outside of a clinical trial,” Wendy A. Woodward, MD, PhD, professor and ad interim chair of the Department of Breast Radiation Oncology in the Division of Radiation Oncology at The University of Texas MD Anderson Cancer Center, stated in a written editorial related to the study.² “When offering non–[GCC] options, it is necessary that patients are informed that these options have not been studied in their disease, and the best outcomes published are among those receiving maximized, not deescalated, therapy.”

References

1. Tadros A, Diskin B, Sevilimedu V, et al. Trends in guideline-concordant care for inflammatory breast cancer. JAMA Netw Open. 2025;8(2):e2454506. doi:10.1001/jamanetworkopen.2024.54506
2. Woodward WA. Deescalation perils in inflammatory breast cancer. JAMA Netw Open. 2025;8(2):e2454513. doi:10.1001/jamanetworkopen.2024.54513