Age bias: a cause of underutilization of breast conservation treatment.
BACKGROUND
Breast conservation therapy (BCT) has been shown to result i about the same disease control and survival as modified radical mastectomy (MRM) for stage I and II breast cancers. Barriers to using BCT in patients with invasive breast cancer include "physician preference." This study was undertaken to investigate the bias of residents with respect to breast-conserving procedures.


METHODS
Internal medicine and surgery residents were instructed about the efficacy of BCT. Subsequently, their opinions were assessed using a questionnaire concerning recommendations for BCT versus MRM as well as breast reconstruction after MRM in similar patients. Chi square tests were used for statistical analysis.


RESULTS
Seventy-nine residents (54 medical, 25 surgical) participated. MRM was recommended for 38% of older (> 59 years old) versus 11% of younger patients (< 31 years old), p < 0.01. Furthermore, breast reconstruction was recommended for 96% of younger versus only 70% of older patients (p < 0.01).


CONCLUSIONS
Residents are biased against older women in their recommendations for breast conservation and breast reconstruction. Educational efforts to decrease this age bias should be instituted during residency.
Department of Surgery, Tulane University, School of Medicine, New Orleans, Louisiana, USA.
A K
AK
Madan
S
S
Aliabadi-Wahle
D J
DJ
Beech
D000328:Adult; D017668:Age of Onset; D000368:Aged; D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006300:Health Services Misuse; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D008297:Male; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data*; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011287:Prejudice; D019651:Plastic Surgery Procedures; D011795:Surveys and Questionnaires; D014481:United States