Comparison of treatment of early-stage breast cancer among Nurses’ Health Study participants and other Medicare beneficiaries

  • Andrea M. AustinEmail author
  • Nirav S. Kapadia
  • Gabriel A. Brooks
  • Tracy L. Onega
  • A. Heather Eliassen
  • Rulla M. Tamimi
  • Michelle Holmes
  • Qianfei Wang
  • Francine Grodstein
  • Anna N. A. Tosteson



Increasingly epidemiological cohorts are being linked to claims data to provide rich data for healthcare research. These cohorts tend to be different than the general United States (US) population. We will analyze healthcare utilization of Nurses’ Health Study (NHS) participants to determine if studies of newly diagnosed incident early-stage breast cancer can be generalized to the broader US Medicare population.


Analytic cohorts of fee-for-service NHS–Medicare-linked participants and a 1:13 propensity-matched SEER–Medicare cohort (SEER) with incident breast cancer in the years 2007–2011 were considered. Screening leading to, treatment-related, and general utilization in the year following early-stage breast cancer diagnosis were determined using Medicare claims data.


After propensity matching, NHS and SEER were statistically balanced on all demographics. NHS and SEER had statistically similar rates of treatments including chemotherapy, breast-conserving surgery, mastectomy, and overall radiation use. Rates of general utilization include those related to hospitalizations, total visits, and emergency department visits were also balanced between the two groups. Total spending in the year following diagnosis were statistically equivalent for NHS and SEER ($36,180 vs. $35,399, p = 0.70).


NHS and the general female population had comparable treatment and utilization patterns following diagnosis of early-stage incident breast cancers with the exception of type of radiation therapy received. This study provides support for the larger value of population-based cohorts in research on healthcare costs and utilization in breast cancer.


Breast cancer Epidemiology Nurses’ Health Study Generalizability study 



We would like to thank the participants and staff of the Nurses’ Health Study for their valuable contributions as well as the following state cancer registries for their help: AL, AZ, AR, CA, CO, CT, DE, FL, GA, ID, IL, IN, IA, KY, LA, ME, MD, MA, MI, NE, NH, NJ, NY, NC, ND, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, WY. The authors assume full responsibility for analyses and interpretation of these data.

Author Contributions

All authors contributed to the study conception and design; AMA and QW analyzed the data. AMA, ANAT, and FG prepared the manuscript. All authors provided critical revisions to the manuscript.


Supported by the National Cancer Institute (Grant Number UM1CA186107).

Compliance with ethical standards

Conflict of interest

All the authors declare that they have no conflict of interest.

Research involving human and animal participants

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

This study utilizes retrospective, de-identified information. Informed consent was not necessary.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Andrea M. Austin
    • 1
    Email author
  • Nirav S. Kapadia
    • 1
    • 2
    • 3
  • Gabriel A. Brooks
    • 1
    • 2
    • 3
  • Tracy L. Onega
    • 1
    • 3
  • A. Heather Eliassen
    • 4
    • 5
  • Rulla M. Tamimi
    • 4
    • 5
  • Michelle Holmes
    • 5
  • Qianfei Wang
    • 1
  • Francine Grodstein
    • 4
    • 5
  • Anna N. A. Tosteson
    • 1
    • 2
    • 3
  1. 1.The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at DartmouthHanoverUSA
  2. 2.Department of MedicineDartmouth-Hitchcock Medical CenterLebanonUSA
  3. 3.Norris Cotton Cancer CenterLebanonUSA
  4. 4.Channing Division of Network Medicine, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA
  5. 5.Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonUSA

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