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Patterns of breast carcinoma treatment in older women
Author(s) -
Mandelblatt Jeanne S.,
Hadley Jack,
Kerner Jon F.,
Schulman Kevin A.,
Gold Karen,
DunmoreGriffith Jackie,
Edge Stephen,
Guadagnoli Edward,
Lynch John J.,
Meropol Neal J.,
Weeks Jane C.,
Winn Rodger
Publication year - 2000
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(20000801)89:3<561::aid-cncr11>3.0.co;2-a
Subject(s) - medicine , radiation therapy , mastectomy , odds ratio , breast cancer , confidence interval , breast carcinoma , logistic regression , population , breast conserving surgery , demography , gynecology , surgery , cancer , environmental health , sociology
BACKGROUND Older women have high rates of breast carcinoma, and there are substantial variations in the patterns of care for this population group. METHODS The authors studied 718 breast carcinoma patients age 67 years and older who were diagnosed with localized disease between 1995 and 1997 from 29 hospitals in 5 regions. Data were collected from patients, charts, and surgeons. Logistic regression analysis was used to evaluate determinants of treatment. RESULTS Women who were concerned about body image were 1.8 times more likely (95% confidence interval [95% CI], 1.1–2.8) to receive breast conservation surgery and radiotherapy than women without this preference, controlling for other factors. In contrast, women who preferred receiving no therapy beyond surgery were 3.9 times more likely (95% CI, 2.9–6.1) to undergo mastectomy than other women, after considering other factors. Radiotherapy was omitted after breast conservation 3.4 times more often (95% CI, 2.0–5.6) among women age 80 years and older than among women ages 67–79 years, controlling for covariates. Black women tended to have radiotherapy omitted after breast conservation surgery 2.0 times more often (95% CI, 0.9–4.4) than white women ( P = 0.09). Women age 80 years and older also were 70% less likely (odds ratio = 0.3; 95% CI, 0.1–0.8) to receive chemotherapy than women ages 67–79 years, controlling for health, functional status, and other covariates. CONCLUSIONS After considering other factors, patient preferences and age were found to be associated with breast carcinoma treatment patterns in older women. Further research and training are needed to provide care for the growing population of older women that is both clinically appropriate and consonant with a woman's preferences. Cancer 2000;89:561–73. © 2000 American Cancer Society.