title: Breast conserving surgery versus mastectomy: the influence of comorbidities on choice of surgical operation in the Department of Defense health care system.
abstract: BACKGROUND
  Studies on the effect of comorbidities on breast cancer operation have been limited and inconsistent. This study investigated whether pre-existing comorbidities influenced breast cancer surgical operation in an equal access health care system.
  
  
  METHODS
  This study was based on linked Department of Defense cancer registry and medical claims data. The study subjects were patients diagnosed with stage I to III breast cancer during 2001 to 2007. Logistic regression was used to determine if comorbidity was associated with operation type and time between diagnosis and operation.
  
  
  RESULTS
  Breast cancer patients with comorbidities were more likely to receive mastectomy (odds ratio [OR] = 1.27; 95% confidence interval [CI], 1.14 to 1.42) than breast conserving surgery plus radiation. Patients with comorbidities were also more likely to delay having operation than those without comorbidities (OR = 1.27; 95% CI, 1.14 to 1.41).
  
  
  CONCLUSIONS
  In an equal access health care system, comorbidity was associated with having a mastectomy and with a delay in undergoing operation.
authors.affiliation: John P. Murtha Cancer Center, Bethesda, MD, USA.
authors.forename: Jing
authors.initials: J
authors.lastname: Zhou
authors.forename: Lindsey
authors.initials: L
authors.lastname: Enewold
authors.forename: Shelia H
authors.initials: SH
authors.lastname: Zahm
authors.forename: Ismail
authors.initials: I
authors.lastname: Jatoi
authors.forename: Craig
authors.initials: C
authors.lastname: Shriver
authors.forename: William F
authors.initials: WF
authors.lastname: Anderson
authors.forename: Diana D
authors.initials: DD
authors.lastname: Jeffery
authors.forename: Abegail
authors.initials: A
authors.lastname: Andaya
authors.forename: John F
authors.initials: JF
authors.lastname: Potter
authors.forename: Katherine A
authors.initials: KA
authors.lastname: McGlynn
authors.forename: Kangmin
authors.initials: K
authors.lastname: Zhu
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D006077:Government Agencies; D006801:Humans; D016015:Logistic Models; D008408:Mastectomy / Q000706:statistics & numerical data*; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data*; D008875:Middle Aged; D008889:Military Personnel; D009367:Neoplasm Staging; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012042:Registries; D013997:Time Factors; D014481:United States
keywords: Breast cancer; Breast conserving surgery; Comorbidity; Department of Defense health system; Mastectomy; Military