An analysis of factors determining the use of breast conserving surgery for treating early-stage breast cancer.

To determine the trend of breast conserving surgery (BCS) in West Virginia and to identify patient, hospital and surgeon factors associated with use of BCS, we conducted a study of all cases of Stage I and II invasive breast cancer treated surgically in West Virginia from 1991 through 1995 (N = 2411). These records were obtained from the State Cancer Registry. Multiple logistic regression was used to generate odds ratios (or) and 95% confidence intervals (CI) to determine factors associated with BCS. Our results showed the rate of BCS increased from 25% in 1991 to 37% in 1994 and 33% in 1995, with an overall rate of 33%. Multiple logistic regression identified the following factors associated with BCS: tumor size less than 1 cm (or = 1.47, 95% C1 = 1.4, 1.5), hospital bed size > 300 beds (or = 1.3, 95% C1 = 1.05-1.6) and a surgeon who had graduated from medical school since 1981 (or = 1.2, 95% C1 = 1.0, 1.36). We conclude the rate of BCS in West Virginia still remains low and that the women least likely to have BCS were women with tumors > 2 cm treated at small hospitals by older physicians.