Surgical treatment of breast cancer among the elderly in the United States

Authors

  • Amy K. Alderman MD, MPH,

    Corresponding author
    1. Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan
    • Department of Plastic and Reconstructive Surgery, University of Michigan, 2130 Taubman Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0340
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    • Fax: (734) 763-5354

  • Julie Bynum MD, MPH,

    1. Department of Medicine, Dartmouth Medical School, Hanover, New Hampshire
    2. The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
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  • Jason Sutherland PhD,

    1. University of British Columbia Centre for Health Services and Policy Research, Vancouver, British Columbia, Canada
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  • Nancy Birkmeyer PhD,

    1. Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan
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  • E. Dale Collins MD, MS,

    1. The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
    2. Department of Surgery, Dartmouth Medical School, Hanover, New Hampshire
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  • John Birkmeyer MD

    1. Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan
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Abstract

BACKGROUND:

Breast-conserving therapy (BCT) has emerged as the preferred treatment for most women with early stage breast cancer. However, there is concern for underuse in the elderly, with previously documented low rates of BCT and large variations in practice patterns. The authors' purpose was to examine patterns and correlates of BCT for breast cancer in the elderly US population.

METHODS:

The primary outcome was receipt of BCT. The 2003 to 2004 Medicare inpatient, outpatient, and carrier files were used to identify incident breast cancer patients and the American Medical Association to ascertain surgeon information. The primary independent variables were US state where treatment was performed along with patient and surgeon sociodemographic information. Multivariate logistic regression was used for the analyses.

RESULTS:

BCT was performed in 81.8% of patients (N = 20,032). Variation in use of BCT across states was low, ranging from 74.2% in Utah to 84.0% in New Mexico. Several factors were significantly associated with low use of BCT: advanced patient age (>85 vs <70 years: odds ratio [OR], 0.50; 95% confidence interval [CI], 0.42-0.59); comorbidities (>3 vs ≤3: OR, 0.26; 95% CI, 0.24-0.28), and low socioeconomic status (SES) (lowest quintile vs highest quintile SES: OR, 0.60; 95% CI, 0.52-0.68). Variation in use of BCT by surgeon was low, although female surgeons aged 40 to 49 years and ≥60 years had significantly higher use compared with younger men.

CONCLUSIONS:

BCT has become the primary management among elderly breast cancer patients. Despite earlier studies to the contrary, there is now little variation in BCT use among Medicare patients. Cancer 2011. © 2010 American Cancer Society.

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