PURPOSE: To assess the use of breast-conserving surgery in two states reported to differ with respect to surgical treatment of breast cancer. METHODS: A retrospective cohort study based on data collected from medical records and patients was performed among 1,514 patients diagnosed with early-stage breast cancer in Massachusetts and 1,061 patients in Minnesota. Patients were identified at 18 randomly selected hospitals in Massachusetts and at 30 hospitals in Minnesota. The rate of breast-conserving surgery in both states and the correlates of breast-conserving surgery among women eligible for the procedure were determined. RESULTS: The rate of breast-conserving surgery in both states was much higher than previously reported. Among those eligible for the procedure, nearly 75% underwent breast-conserving surgery in Massachusetts and nearly half did so in Minnesota. Significantly (P < .003) more women who underwent mastectomy in Minnesota (27%) than in Massachusetts (15%) reported that their surgeon did not discuss breast-conserving surgery with them. Among women who underwent mastectomy and who reported being informed of both surgical alternatives, more women (P < .001) in Minnesota (74%) than in Massachusetts (62%) said they ultimately chose mastectomy because their surgeon recommended it. In Massachusetts, women treated at teaching hospitals were twice as likely as other women to undergo breast-conserving surgery. In Minnesota, women over age 70 and those who lived in rural areas were less likely than other women to undergo breast-conserving surgery. CONCLUSION: Although the rate of breast-conserving surgery in each state was higher than expected based on earlier reports, the rates differed considerably between states. Additional studies are needed to determine whether variation in practice between geographic areas is due to differences in patients' preferences and values or to surgeons' propensity for one type of surgery based on where they practice.
PURPOSE: To assess the use of breast-conserving surgery in two states reported to differ with respect to surgical treatment of breast cancer. METHODS: A retrospective cohort study based on data collected from medical records and patients was performed among 1,514 patients diagnosed with early-stage breast cancer in Massachusetts and 1,061 patients in Minnesota. Patients were identified at 18 randomly selected hospitals in Massachusetts and at 30 hospitals in Minnesota. The rate of breast-conserving surgery in both states and the correlates of breast-conserving surgery among women eligible for the procedure were determined. RESULTS: The rate of breast-conserving surgery in both states was much higher than previously reported. Among those eligible for the procedure, nearly 75% underwent breast-conserving surgery in Massachusetts and nearly half did so in Minnesota. Significantly (P < .003) more women who underwent mastectomy in Minnesota (27%) than in Massachusetts (15%) reported that their surgeon did not discuss breast-conserving surgery with them. Among women who underwent mastectomy and who reported being informed of both surgical alternatives, more women (P < .001) in Minnesota (74%) than in Massachusetts (62%) said they ultimately chose mastectomy because their surgeon recommended it. In Massachusetts, women treated at teaching hospitals were twice as likely as other women to undergo breast-conserving surgery. In Minnesota, women over age 70 and those who lived in rural areas were less likely than other women to undergo breast-conserving surgery. CONCLUSION: Although the rate of breast-conserving surgery in each state was higher than expected based on earlier reports, the rates differed considerably between states. Additional studies are needed to determine whether variation in practice between geographic areas is due to differences in patients' preferences and values or to surgeons' propensity for one type of surgery based on where they practice.
Authors: Raimund Jakesz; Hellmut Samonigg; Michael Gnant; Ernst Kubista; Dieter Depisch; Roland Kolb; Brigitte Mlineritsch; Hans-Jörg Mischinger; Rainer-Christian Menzel; Peter Steindorfer; Werner Kwasny; Christoph Tausch; Michael Stierer; Susanne Taucher; Michael Seifert; Hubert Hausmaninger Journal: Ann Surg Date: 2003-04 Impact factor: 12.969
Authors: Celia P Kaplan; Anna M Nápoles; E Shelley Hwang; Joan Bloom; Susan Stewart; Dana Nickleach; Leah Karliner Journal: J Womens Health (Larchmt) Date: 2010-12-03 Impact factor: 2.681
Authors: Nancy L Keating; Mary Beth Landrum; John M Brooks; Elizabeth A Chrischilles; Eric P Winer; Kara Wright; Rita Volya Journal: Breast Cancer Res Treat Date: 2010-04-08 Impact factor: 4.872
Authors: Myung Kyung Lee; Dong Young Noh; Seok Jin Nam; Se Hyun Ahn; Byeong Woo Park; Eun Sook Lee; Young Ho Yun Journal: BMC Health Serv Res Date: 2010-02-23 Impact factor: 2.655
Authors: Jack Hadley; Jeanne S Mandelblatt; Jean M Mitchell; Jane C Weeks; Edward Guadagnoli; Yi-Ting Hwang Journal: Health Serv Res Date: 2003-04 Impact factor: 3.402