title: The use of breast-conserving surgery for women treated for breast cancer in the Department of Veterans Affairs.
abstract: BACKGROUND
  Previous non-stage-adjusted research described a lower use of breast-conserving surgery (BCS) for the treatment of breast cancer in the Veterans Health Administration (VHA) facilities than in the private sector.
  
  
  METHODS
  We combined data from the VHA Centralized Cancer Registry with administrative datasets to describe surgical treatment for locoregional breast cancer in VHA facilities from 2000 to 2006.
  
  
  RESULTS
  When considering only procedures performed in VHA facilities, BCS rates decreased from 50.5% (53/105) in 2000 to 42.3% (n = 58/137) in 2006; however, after accounting for procedures conducted in the private sector and paid for by the VHA, BCS rates approached those experienced in breast cancer patients cared for outside the VHA.
  
  
  CONCLUSIONS
  Based solely on procedures performed in the VHA, rates of BCS use are much lower in the VHA than in the private sector. We were able to show similar rates of BCS use when we accounted for procedures paid for by the VHA but performed at an outside facility. Further exploration and prospective analyses to examine these findings are needed.
authors.affiliation: HSR&D/RR&D Center of Excellence: Maximizing Rehabilitation Outcomes, James A. Haley Veterans Hospital, 8900 Grand Oak Circle, Tampa, FL 33637-1022, USA. steve.luther@med.va.gov
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Luther
authors.forename: Leigh
authors.initials: L
authors.lastname: Neumayer
authors.forename: William G
authors.initials: WG
authors.lastname: Henderson
authors.forename: Phillip
authors.initials: P
authors.lastname: Foulis
authors.forename: Matthew
authors.initials: M
authors.lastname: Richardson
authors.forename: Jolie
authors.initials: J
authors.lastname: Haun
authors.forename: Margaret
authors.initials: M
authors.lastname: Mikelonis
authors.forename: Amy
authors.initials: A
authors.lastname: Rosen
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D001943:Breast Neoplasms / Q000191:economics / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D015411:Mastectomy, Modified Radical / Q000706:statistics & numerical data; D015412:Mastectomy, Segmental / Q000191:economics / Q000706:statistics & numerical data*; D008498:Medical Record Linkage; D008875:Middle Aged; D009367:Neoplasm Staging; D017149:Private Sector / Q000191:economics / Q000706:statistics & numerical data; D012042:Registries; D012189:Retrospective Studies; D018426:SEER Program; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data*