title: Consultation with a medical oncologist before surgery and type of surgery among elderly women with early-stage breast cancer.
abstract: OBJECTIVE
  Prior studies have documented variation in breast cancer treatment and care that does not follow guideline recommendations, particularly for elderly women. We assessed whether consultation with a medical oncologist before surgery was associated with use of definitive surgery, axillary node dissection, and type of surgery.
  
  
  METHODS
  We conducted a retrospective cohort study of a population-based sample of 9,630 women aged > or = 66 years diagnosed with breast cancer during 1995 to 1996. We measured the adjusted proportion visiting a medical oncologist before surgery, identified factors associated with such visits, and assessed the association between visits with a medical oncologist and use of definitive surgery (mastectomy or breast-conserving surgery with radiation v breast-conserving surgery without radiation); axillary dissection; and breast-conserving surgery versus mastectomy among women undergoing definitive surgery.
  
  
  RESULTS
  Nineteen percent of women visited a medical oncologist before surgery; these women were younger, more often had larger or more poorly differentiated cancers, had more comorbid illnesses, and were treated more often at a teaching hospital (all P <.05). Women who saw a medical oncologist before surgery were more likely than others to undergo definitive surgery (adjusted odds ratio [OR], 1.28; 95% CI, 1.05 to 1.56) and axillary dissection (adjusted OR, 1.44; 95% CI, 1.19 to 1.73), but less likely to undergo breast-conserving surgery among women undergoing definitive surgery (OR, 0.84; 95% CI, 0.75 to 0.95).
  
  
  CONCLUSIONS
  Elderly women who consulted with a medical oncologist before surgery were more likely to receive guideline-recommended care. Additional research is needed allow a better understanding of the quality and content of discussions that elderly women have with various providers about breast-conserving surgery and mastectomy.
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, and Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA. keating@hcp.med.harvard.edu
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Keating
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Landrum
authors.forename: John Z
authors.initials: JZ
authors.lastname: Ayanian
authors.forename: Eric P
authors.initials: EP
authors.lastname: Winer
authors.forename: Edward
authors.initials: E
authors.lastname: Guadagnoli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla / Q000601:surgery; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D016015:Logistic Models; D008197:Lymph Node Excision; D008495:Medical Oncology; D010358:Patient Participation; D012017:Referral and Consultation; D012189:Retrospective Studies; D018426:SEER Program; D014481:United States