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Factors associated with surgical options for breast carcinoma†

  1. Anees B. Chagpar M.D., M.Sc.1,‡,*,
  2. Jamie L. Studts Ph.D.2,
  3. Charles R. Scoggins M.D.1,
  4. Robert C.G. Martin 2nd M.D.1,
  5. David J. Carlson M.D.3,
  6. Alison L. Laidley M.D.4,
  7. Souzan E. El-Eid M.D.5,
  8. Terre Q. McGlothin M.D.4,
  9. Robert D. Noyes M.D.6,
  10. Kelly M. McMasters M.D., Ph.D.1,
  11. University of Louisville Breast Sentinel Lymph Node Study§

Article first published online: 8 FEB 2006

DOI: 10.1002/cncr.21728

Issue

Cancer

Cancer

Volume 106, Issue 7, pages 1462–1466, 1 April 2006

Additional Information

How to Cite

Chagpar, A. B., Studts, J. L., Scoggins, C. R., Martin, R. C., Carlson, D. J., Laidley, A. L., El-Eid, S. E., McGlothin, T. Q., Noyes, R. D., McMasters, K. M. and University of Louisville Breast Sentinel Lymph Node Study (2006), Factors associated with surgical options for breast carcinoma. Cancer, 106: 1462–1466. doi: 10.1002/cncr.21728

Author Information

  1. 1

    Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Kentucky

  2. 2

    Division of Hematology/Oncology, University of Louisville, Department of Medicine, Louisville, Kentucky

  3. 3

    St. Mary's Medical Center and Deaconess Hospital, Evansville, Indiana

  4. 4

    Breast Surgeons of North Texas, Dallas, Texas

  5. 5

    Hudson Valley Surgical, Kingston, New York

  6. 6

    Latter Day Saints Hospital, Salt Lake City, Utah

  1. ‡

    Fax: (502) 629-3183

  2. §

    A complete list of investigators in the University of Louisville Breast Sentinel Lymph Node Study is published in Am J Surg. 2002;184:496–8.

*Division of Surgical Oncology, Department of Surgery, University of Louisville, 315 East Broadway, Suite #312, Louisville, KY

  1. †

    Presented at the American Society of Breast Diseases Meeting, Las Vegas, Nevada, April 14–16, 2005.

Publication History

  1. Issue published online: 16 MAR 2006
  2. Article first published online: 8 FEB 2006
  3. Manuscript Accepted: 5 OCT 2005
  4. Manuscript Revised: 8 SEP 2005
  5. Manuscript Received: 9 AUG 2005

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Keywords:

  • breast carcinoma;
  • treatment;
  • surgery;
  • lumpectomy;
  • mastectomy

In a prospective multicenter study, multivariate analyses were performed to determine factors that influence the decision between mastectomy and breast conservation surgery in women with breast carcinoma. Whereas clinicopathologic variables such as patient age, tumor size, tumor palpability, tumor location in the breast, and histologic subtype were all found to be independent determinants of surgery type, geographic location and the academic affiliation of the surgeon were also important predictors in the multivariate model.

Abstract

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.

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