title: The effect of less than definitive care on breast carcinoma recurrence and mortality.
abstract: BACKGROUND
  Risk factors for breast carcinoma offer few opportunities for prevention; thus, the reduction of morbidity and mortality among breast carcinoma patients must remain a priority. The objective of this study was to measure the effects of less than definitive care for patients with breast carcinoma on disease recurrence and mortality.
  
  
  METHODS
  The prognostic evaluation and treatment received by an inception cohort of 494 women was characterized. Three hundred ninety women ages 45-90 years with local or regional breast carcinoma who were diagnosed between 1984 and 1986 and were treated at one of eight Rhode Island hospitals comprised the final cohort. Disease recurrence and mortality were ascertained through December 31, 1996. Candidate determinants of outcomes were a less than definitive prognostic evaluation and less than definitive primary therapy-adjusted for confounding by patient age, extent of disease, and comorbid diseases.
  
  
  RESULTS
  During the first 5 years of follow-up, patients who received a less than definitive prognostic evaluation had an adjusted relative hazard of recurrence of 1.7 (95% confidence interval, 1.0-2.7) and an adjusted relative hazard for breast carcinoma mortality of 2.2 (95% confidence interval, 1.2-3.9). Patients who received less than definitive therapy had an adjusted relative hazard of recurrence of 1.6 (95% confidence interval, 1.0-2.5), and an adjusted relative hazard of breast carcinoma mortality of 1.7 (95% confidence interval, 1.0-2.8).
  
  
  CONCLUSIONS
  Breast carcinoma patients who receive less than definitive care are at excess risk for disease recurrence and mortality. Women with early stage breast carcinoma should be treated in accordance with existing guidelines.
authors.affiliation: Department of Epidemiology and Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA. tlash@bu.edu
authors.forename: T L
authors.initials: TL
authors.lastname: Lash
authors.forename: R A
authors.initials: RA
authors.lastname: Silliman
authors.forename: E
authors.initials: E
authors.lastname: Guadagnoli
authors.forename: V
authors.initials: V
authors.lastname: Mor
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D015897:Comorbidity; D016001:Confidence Intervals; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D012237:Rhode Island / Q000453:epidemiology; D012307:Risk Factors; D016019:Survival Analysis