Determinants of receiving breast-conserving surgery. The surveillance, epidemiology, and end results program, 1983–1986

Abstract

Background. Although breast‐conserving surgery was used with increasing frequency during the 1980s for management of breast cancer, most women still undergo mastectomy, and a substantial variation has been documented in the proportion of women receiving breast‐conserving surgery across regions of the country. Using data from the Surveillance, Epidemiology, and End Results (SEER) Program for 1983–1986, we assessed characteristics of the county of residence as predictors of receipt of breast‐conserving surgery and determined whether regional variation persisted after considering these characteristics. Methods. The data used involved all 19,661 non‐Hispanic white women with localized breast cancer diagnosed in 1983 through 1986 in the nine SEER regions. Information on county characteristics was obtained from standard sources and merged with the SEER data. Univariate and multivariate statistical methods were used to assess the effects of county characteristics on type of surgery for breast cancer. Results. As anticipated, age was a strong predictor of type of surgery. In analyses that controlled for age, county characteristics that significantly predicted receipt of breast‐conserving surgery included physician‐to‐population ratio, education and income levels, the presence of a cancer center, and the presence of a city of at least 100,000. After controlling for these factors using multiple logistic regression, substantial regional variation persisted. Conclusions. Regional variation in treatment of localized breast cancer across the SEER regions is not explained by patient's age or county characteristics. Research is needed to address the decision making of individual patients and their physicians regarding type of surgery.

Feasibility of concervative breast surgery and intraoperative radiation therapy for early breast cancer: A single-center, open, non-randomized, prospective pilot study

“…Finally, it was demonstrated that breast conservative surgery depends on the age of the patient, on the geographic region of the patient, and on the distance from radiotherapy centers (2,23–25). Age is also the major influencing factor for patient compliance to EBRT after breast conservative surgery, which results in ~18% of women aged <50 up to 37% in patients aged >70 years (2).…”

Geographical Differences in Primary Therapy for Early-Stage Breast Cancer

“…13,30 Consistent with other studies, we found geographical variation in use of breast-conserving therapy for women with early-stage disease. [12][13][14][15][16] We extended that information by comparing treatment of women according to exact geographical coordinates for their place of residence at the time of diagnosis. With one exception, 16 prior analyses were based on a great level of data aggregation (i.e., region of the country, state, county).…”

“…9 -11 Noteworthy variation in the geography of breast-conserving surgery, not readily attributable to patient or disease characteristics, has been reported. 12 Rushton and West 13 reported sizable variation in mastectomy rates for localized breast cancer across Iowa, as did Guadagnoli et al 14 and Nattinger et al 15 across regions of the United States. Polednak 16 found rates of breast-conserving surgery to be high among Connecticut residents who resided near a particular hospital.…”

A retrospective study of the impact of age on patterns of care for elderly patients with metastatic breast cancer

“…When treating elderly patients with cancer, especially with chemotherapy, oncologists should pay careful attention to the treatment procedure and consider dose modification depending on the drugs [7]. Some reports suggest that elderly patients with breast cancer are less likely to receive breast conservation surgery, radiation, and chemotherapy [8][9][10][11][12][13][14][15][16]. These may indicate both patient and physician preferences toward avoiding cytotoxic agents [10].…”