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Factors associated with surgical options for breast carcinoma
Author(s) -
Chagpar Anees B.,
Studts Jamie L.,
Scoggins Charles R.,
Martin Robert C.G.,
Carlson David J.,
Laidley Alison L.,
ElEid Souzan E.,
McGlothin Terre Q.,
Noyes Robert D.,
McMasters Kelly M.
Publication year - 2006
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/cncr.21728
Subject(s) - medicine , mastectomy , confidence interval , odds ratio , breast carcinoma , breast cancer , breast conserving surgery , multivariate analysis , breast surgery , carcinoma , prospective cohort study , gynecology , surgery , cancer
BACKGROUND Breast conservation surgery (BCS) and mastectomy have equivalent survival outcomes for women with breast carcinoma, but treatment decisions are affected by many factors. The current study evaluated the impact of patient and physician factors on surgical decision‐making. METHODS Statistical analyses were performed on a prospective multicenter study of patients with invasive breast carcinoma. Patient, physician, and geographic factors were considered. RESULTS Of 4086 patients, BCS was performed in 2762 (67.6%) and mastectomy was performed in 1324 (32.4%). The median tumor size was 1.5 cm (range, < 0.1–9.0 cm) in patients undergoing BCS and 1.9 cm (range, 0.1–11.0 cm) in patients undergoing mastectomy ( P < 0.00001). The median age of patients undergoing BCS was 59 years (range, 27–100 yrs), whereas patients who underwent mastectomy were older (median age of 63 yrs, range, 27–96 yrs [ P < 0.00001]). Physicians in academic practices performed more lumpectomies than those who were not in an academic practice (70.9% vs. 65.7%; P = 0.001). More breast conservation procedures were performed by surgeons with a higher percentage of breast practice ( P = 0.012). Geographic location was found to be significant, with the Northeast having the highest rate of breast conservation (70.8%) and the Southeast having the lowest (63.2%; P = 0.002). On multivariate analysis, patient age (odds ratio [OR]: 1.455; 95% confidence interval [95% CI], 1.247–1.699 [ P < 0.001]), tumor size ( P < 0.001), tumor palpability (OR: 0.613; 95% CI, 0.524–0.716 [ P < 0.001]), histologic subtype ( P = 0.018), tumor location in the breast ( P < 0.001), physician academic affiliation (OR: 1.193; 95% CI: 1.021–1.393 [ P = 0.026]), and geographic location ( P = 0.045) were found to be significant. CONCLUSIONS Treatment decisions were found to be related to patient clinicopathologic features, surgeon academic affiliation, and geographic location. Future studies will elucidate the communication and psychosocial factors that may influence patient decision‐making. Cancer 2006. © 2006 American Cancer Society.