title: Are lower rates of surgery amongst older women with breast cancer in the UK explained by co-morbidity?
abstract: BACKGROUND
  Around 60% of women ≥ 80 years old, in the UK do not have surgery for their breast cancer (vs<10% of younger age groups). The extent to which this difference can be accounted for by co-morbidity has not been established.
  
  
  METHODS
  A Cancer Registry/Hospital Episode Statistics-linked data set identified women aged ≥ 65 years diagnosed with invasive breast cancer (between 1 April 1997 and 31 March 2005) in two regions of the UK (n=23038). Receipt of surgery by age was investigated using logistic regression, adjusting for co-morbidity and other patient, tumour and treatment factors.
  
  
  RESULTS
  Overall, 72% of older women received surgery, varying from 86% of 65-69-year olds to 34% of women aged ≥ 85 years. The proportion receiving surgery fell with increasing co-morbidity (Charlson score 0=73%, score 1=66%, score 2+=49%). However, after adjustment for co-morbidity, older age still predicts lack of surgery. Compared with 65-69-year olds, the odds of surgery decreased from 0.74 (95% CI: 0.66-0.83) for 70-74-year olds to 0.13 (95% CI: 0.11-0.14) for women aged ≥ 85 years.
  
  
  CONCLUSIONS
  Although co-morbidity is associated with a reduced likelihood of surgery, it does not explain the shortfall in surgery amongst older women in the UK. Routine data on co-morbidity enables fairer comparison of treatment across population groups but needs to be more complete.
authors.affiliation: School of Nursing, Midwifery and Social Work, The University of Manchester, 5.332 Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK. katrina.j.lavelle@manchester.ac.uk
authors.forename: K
authors.initials: K
authors.lastname: Lavelle
authors.forename: A
authors.initials: A
authors.lastname: Downing
authors.forename: J
authors.initials: J
authors.lastname: Thomas
authors.forename: G
authors.initials: G
authors.lastname: Lawrence
authors.forename: D
authors.initials: D
authors.lastname: Forman
authors.forename: S E
authors.initials: SE
authors.lastname: Oliver
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D006801:Humans; D012042:Registries; D006113:United Kingdom / Q000453:epidemiology