title: Treatment differences and other prognostic factors related to breast cancer survival. Delivery systems and medical outcomes.
abstract: OBJECTIVE
  To determine differences in and relative importance of treatment modalities by hospital type and their effect on survival of breast cancer patients.
  
  
  METHODS
  Cohort of population-based cancer registry breast cancer patients diagnosed from 1984 through 1990. The analysis was done within this cohort, stratified by hospital type and treatment modality.
  
  
  METHODS
  Orange County, California, residents diagnosed and treated for breast cancer in 126 hospitals (small community, large community, health maintenance organization [HMO], or teaching).
  
  
  METHODS
  A total of 5892 non-Hispanic white women with no known prior cancer and with localized or regional, histologically confirmed breast cancer.
  
  
  METHODS
  Effects of treatment modality and hospital type on survival. Adjustments for differences in age, tumor size, number of positive lymph nodes, and histology were included in the analysis.
  
  
  RESULTS
  Use of recommended breast-conserving surgery (BCS) was greatest among teaching hospitals, where more than 50% of patients with localized disease received BCS between 1988 and 1990 and 40% to 50% with regional disease received BCS between 1984 and 1990. At nonteaching hospitals, 30% or less of patients received BCS between 1984 and 1989, regardless of stage. Rates of survival after BCS were at least as good as rates of survival after total mastectomy, other factors being equal. Survival rates varied by hospital type for patients with localized disease, with significantly better rates at large community hospitals and significantly worse rates at HMO hospitals in comparison with small hospitals. Patients with regional disease at large hospitals had a significant survival advantage.
  
  
  CONCLUSIONS
  Greater use of BCS is strongly urged. Overall, large community hospitals had significantly better survival rates than small community and HMO hospitals. Further follow-up will determine if treatment and survival differences by hospital type persist.
authors.affiliation: Department of Medicine, University of California--Irvine College of Medicine 92717.
authors.forename: A
authors.initials: A
authors.lastname: Lee-Feldstein
authors.forename: H
authors.initials: H
authors.lastname: Anton-Culver
authors.forename: P J
authors.initials: PJ
authors.lastname: Feldstein
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality* / Q000601:surgery / Q000628:therapy*; D002140:California; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D005260:Female; D006279:Health Maintenance Organizations; D006761:Hospitals / Q000145:classification* / Q000706:statistics & numerical data; D006764:Hospitals, Community; D006784:Hospitals, Teaching; D006801:Humans; D008408:Mastectomy / Q000706:statistics & numerical data*; D008875:Middle Aged; D016522:Oncology Service, Hospital / Q000706:statistics & numerical data*; D011379:Prognosis; D015996:Survival Rate