title: Surgeon characteristics and use of breast conservation surgery in women with early stage breast cancer.
abstract: BACKGROUND
  Most women with localized breast cancer have a choice between mastectomy and breast conserving surgery (BCS). Aside from clinical factors, this decision may be associated with surgeon and patient characteristics. We investigated the effect of surgeon characteristics on the BCS rate.
  
  
  METHODS
  We used the Surveillance, Epidemiology, and End Results-Medicare database to identify women >65 years, diagnosed with stages I-II BC, between 1991 and 2002, and used the Physician Unique Identification Number linked to the American Medical Association Masterfile to obtain information on surgeons. We investigated the association of patient demographic, tumor, and surgeon-related factors with receipt of BCS, using Generalized Estimating Equations to control for clustering.
  
  
  RESULTS
  Of 56,768 women with breast cancer, 30,006 (53%) underwent BCS, whereas 26,762 (47%) underwent mastectomy. Between 1991 and 2002, the proportion of patients undergoing BCS increased from 35% to 60%. In a multivariate analysis, patients who received BCS were younger, of higher SES, and had more favorable tumor characteristics. They were also more likely to be black and live in metropolitan areas. Women who underwent BCS were more likely to have surgeons who were female (OR = 1.40; 95% CI: 1.25-1.55), US-trained (OR = 1.12; 95% CI: 1.02-1.22), with a larger patient panel (OR = 1.29; 95% CI: 1.21-1.39), and completed training after 1975 (OR = 1.16; 95% CI: 1.08-1.25), than surgeons of patients who underwent mastectomy.
  
  
  CONCLUSIONS
  Surgeon characteristics, such as gender, training, year of graduation, and volume, are small but significant independent predictor of BCS. Efforts to differentiate whether these associations reflect patients' preferences, quality of physician training, surgeon attitudes, physician-patient communication, or other effects on decision-making are warranted.
authors.affiliation: Department of Medicine, College of Physicians and Surgeons, Columbia University, New York Presbyterian Hospital, New York, New York 10032, USA. dlh23@columbia.edu
authors.forename: Dawn L
authors.initials: DL
authors.lastname: Hershman
authors.forename: Donna
authors.initials: D
authors.lastname: Buono
authors.forename: Judith S
authors.initials: JS
authors.lastname: Jacobson
authors.forename: Russell B
authors.initials: RB
authors.lastname: McBride
authors.forename: Wei Yann
authors.initials: WY
authors.lastname: Tsai
authors.forename: Kathie Ann
authors.initials: KA
authors.lastname: Joseph
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
mesh_terms: D000368:Aged; D001940:Breast / Q000473:pathology / Q000601:surgery; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D002755:Choice Behavior; D003657:Decision Making; D005260:Female; D013502:General Surgery / Q000706:statistics & numerical data*; D006801:Humans; D008408:Mastectomy / Q000706:statistics & numerical data; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data*; D010820:Physicians / Q000706:statistics & numerical data*; D018426:SEER Program; D014481:United States