title: Surgical treatment of breast cancer among the elderly in the United States.
abstract: BACKGROUND
  Breast-conserving therapy (BCT) has emerged as the preferred treatment for most women with early stage breast cancer. However, there is concern for underuse in the elderly, with previously documented low rates of BCT and large variations in practice patterns. The authors' purpose was to examine patterns and correlates of BCT for breast cancer in the elderly US population.
  
  
  METHODS
  The primary outcome was receipt of BCT. The 2003 to 2004 Medicare inpatient, outpatient, and carrier files were used to identify incident breast cancer patients and the American Medical Association to ascertain surgeon information. The primary independent variables were US state where treatment was performed along with patient and surgeon sociodemographic information. Multivariate logistic regression was used for the analyses.
  
  
  RESULTS
  BCT was performed in 81.8% of patients (N = 20,032). Variation in use of BCT across states was low, ranging from 74.2% in Utah to 84.0% in New Mexico. Several factors were significantly associated with low use of BCT: advanced patient age (>85 vs <70 years: odds ratio [OR], 0.50; 95% confidence interval [CI], 0.42-0.59); comorbidities (>3 vs ≤ 3: OR, 0.26; 95% CI, 0.24-0.28), and low socioeconomic status (SES) (lowest quintile vs highest quintile SES: OR, 0.60; 95% CI, 0.52-0.68). Variation in use of BCT by surgeon was low, although female surgeons aged 40 to 49 years and ≥ 60 years had significantly higher use compared with younger men.
  
  
  CONCLUSIONS
  BCT has become the primary management among elderly breast cancer patients. Despite earlier studies to the contrary, there is now little variation in BCT use among Medicare patients.
authors.affiliation: Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan, USA. aalder@umich.edu
authors.forename: Amy K
authors.initials: AK
authors.lastname: Alderman
authors.forename: Julie
authors.initials: J
authors.lastname: Bynum
authors.forename: Jason
authors.initials: J
authors.lastname: Sutherland
authors.forename: Nancy
authors.initials: N
authors.lastname: Birkmeyer
authors.forename: E Dale
authors.initials: ED
authors.lastname: Collins
authors.forename: John
authors.initials: J
authors.lastname: Birkmeyer
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data*; D006278:Medicare; D010818:Practice Patterns, Physicians'; D014481:United States