Variations in breast conservation surgery for women with axillary lymph node negative breast cancer in British Columbia.
A population-based study was conducted including all women diagnosed in British Columbia in 1991 with invasive node negative breast cancer (n = 942) in order to identify factors associated with variation in use of breast conserving surgery (BCS) and to determine if provincial practice guidelines were followed. Patient, disease, treatment and physician-specific information was abstracted from medical records and original source documents. 413 (44%) patients received BCS (51% and 23% in surgical candidates and non-candidates, respectively). Significant independent factors associated with BCS included patients' age, residence, family income, tumour size, tumour location, and extent of ductal carcinoma in-situ. Age and income had a significant interaction with stronger income effects in older women. A strong surgeon effect was observed which was not explained by measured surgeon attributes. Expansion of radiation treatment facilities may help address access issues. Further examination of the patient-physician relationship and of ways to assist patients in decision making is needed.
Hislop
T G
TG
Division of Epidemiology and Cancer Prevention, BC Cancer Agency, Vancouver.
Olivotto
I A
IA
Coldman
A J
AJ
Trevisan
C H
CH
Kula
J
J
McGregor
G I
GI
Phillips
N
N
D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D001955:British Columbia; D005260:Female; D006801:Humans; D016015:Logistic Models; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D010358:Patient Participation; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies