Breast conserving surgery versus mastectomy: the influence of comorbidities on choice of surgical operation in the Department of Defense health care system

Abstract

BACKGROUND Studies on the effect of comorbidities on breast cancer operation have been limited and inconsistent. This study investigated whether pre-existing comorbidities influenced breast cancer surgical operation in an equal access healthcare system. METHODS This study was based on linked Department of Defense cancer registry and medical claims data. The study subjects were patients diagnosed with stage I–III breast cancer during 2001 to 2007. Logistic regression was used to determine if comorbidity was associated with operation type and time between diagnosis and operation. RESULTS Breast cancer patients with comorbidities were more likely to receive mastectomy (OR=1.27, 95% CI, 1.14–1.42) than breast conserving surgery plus radiation. Patients with comorbidities were also more likely to delay having operation than those without comorbidities (OR=1.27, 95% CI, 1.14–1.41). CONCLUSIONS In an equal access healthcare system, comorbidity was associated with having a mastectomy and with a delay in undergoing operation.

Race/ethnicity and socio-economic differences in breast cancer surgery outcomes

“…In contrast to previous studies [35,36,37] we observed an inverse association between number of comorbidities and receipt of mastectomy. One possible explanation is that our study population was comprised of hospitalized women with breast cancer, who may have been experiencing more severe, acute disease-related events compared with non-admitted survivors [33].…”

Cancer Care at Times of Crisis and War: The Syrian Example

“… 14 Although radiotherapy and lumpectomy have equal benefits to total mastectomy in early stages of the disease, the lack of radiation therapy and specialized breast surgeons may translate to an overly aggressive surgery. 15 , 16 Targeted agents, such as trastuzumab, are of no benefit to Syrian patients with human epidermal growth factor receptor 2 amplifications because of limited availability and expense 17 ; only survey participants from East Ghouta, Homs, and Damascus reported having access to trastuzumab. Furthermore, oncotype diagnostic testing is not available to guide treatment in patients with early-stage breast cancer who could benefit from or avoid chemotherapy.…”

Geographical Inequalities in Surgical Treatment for Localized Female Breast Cancer, Queensland, Australia 1997–2011: Improvements over Time but Inequalities Remain

“…The QCR [ 36 ] does not collect information on potential confounders such as measures of individual socioeconomic status including income, education, and health insurance status [ 15 , 19 , 52 , 60 , 61 ]. Unmeasured variations in general health status at time of breast cancer diagnosis is another possibility as more disadvantaged women are known to have poorer health and a higher prevalence of comorbidities [ 62 ] which may influence treatment decisions [ 30 ]. More disadvantaged women may also experience greater financial and structural barriers to accessing specialised care and/or high-volume hospitals [ 63 , 64 , 65 ] both of which are independent predictors of care in accordance to guidelines (and higher receipt of BCS) [ 23 , 24 , 55 , 56 , 57 ].…”

“…Despite these guidelines, widespread geographical and socioeconomic variations in the clinical management and patterns of care for early stage breast cancer persist, in particular, rural and more disadvantaged women are consistently less likely to receive BCS [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ] than their urban or less disadvantaged counterparts. These disparities are widely attributed to a combination of clinical, demographic, environmental, and healthcare system factors including geographical access to and availability of specialised care, comorbidities, and patient preferences [ 14 , 15 , 16 , 18 , 19 , 21 , 22 , 23 , 25 , 26 , 27 , 28 , 29 , 30 ].…”