title: Analysis of the recourse to conservative surgery in the treatment of breast tumors.
abstract: OBJECTIVE
  Conservative surgery is the treatment of choice for malignant tumors, at least up to stage II. The aim of this study was to analyze the recourse to conservative surgery for breast tumors and its determinants (ie, characteristics of hospitals and patients).
  
  
  METHODS
  The study was conducted in Italy's Lazio region and was based on administrative data of the regional Hospital Information System, a database on hospitalizations. We selected all regional hospitalizations for therapeutic breast surgery over 1997, classifying them as either "conservative" or "non-conservative". The other variables considered were type of hospital, number of beds, volume of activity (average annual number of hospitalizations for breast cancer surgery), specific diagnosis, severity of cancer, and patient's age, place of residence, and socioeconomic level. A logistic model was used for multivariate analysis.
  
  
  RESULTS
  A total of 7235 hospitalizations were analyzed, 3570 (49%) for malignant tumors and 3665 (51%) for benign disease. The logistic model showed that the factors most closely correlated with conservative surgery were age (OR = 2.2; 95% Cl: 1.8-2.6, for the age group <50 years compared to >70 years); severity of cancer (OR = 0.6; 95% Cl: 0.5-0.8, for non-localized compared to localized tumors), and volume of activity of the hospital (OR = 1.3; 95% CI: 1.0-1.6, for hospitals with >70 operations/year compared to those with <20 operations/year). The study also revealed that surgery for malignant tumors was performed by both high-volume and low-volume hospitals throughout the region.
  
  
  CONCLUSIONS
  The association between conservative surgery and younger age, even after controlling for the severity of cancer, points to the need to encourage adherence to the existing guidelines. The association between conservative surgery and high-volume hospitals and the finding that a high proportion of breast operations is performed in low-volume facilities suggest that further efforts should be made to promote admission to high-volume hospitals.
authors.affiliation: Department of Epidemiology, Local Health Unit RME, Rome, Italy. prevanalisi1@asplazio.it
authors.forename: Patrizia
authors.initials: P
authors.lastname: Schifano
authors.forename: Marina
authors.initials: M
authors.lastname: Scarinci
authors.forename: Piero
authors.initials: P
authors.lastname: Borgia
authors.forename: Carlo A
authors.initials: CA
authors.lastname: Perucci
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery*; D002173:Cancer Care Facilities / Q000706:statistics & numerical data; D016208:Databases, Factual; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007558:Italy; D007902:Length of Stay; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009367:Neoplasm Staging; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012923:Social Class