title: A population based study of variations in operation rates for breast cancer, of comorbidity and prognosis at diagnosis: failure to operate for early breast cancer in older women.
abstract: BACKGROUND
  Older women are less likely to have surgery for operable breast cancer. This population-based study examines operation rates by age and identifies groups which present with early or late disease.
  
  
  METHODS
  37 000 cancer registrations for 2007 were combined with Hospital Episode Statistics comorbidity data for England. Operation rates were examined by age, ethnicity, deprivation, comorbidity, screen-detection, tumour size, grade and nodal status. Early and late presentation were correlated with Nottingham Prognostic Index (NPI) groups and tumour size.
  
  
  RESULTS
  The proportion of women not having surgery increased from 7-10% at ages 35-69 to 82% from age 90. From age 70, the proportion not having surgery rose by an average of 3.1% per year of age. Women with a Charlson Comorbidity Index score of ≥1 (which increased with age), with tumours >50 mm or who were node positive, were less likely to have surgery. Although women aged 70-79 were more likely to have larger tumours, their tumours were also more likely to have an excellent or good NPI (p < 0.001). Good prognosis tumours were more likely to be screen-detected, and less likely in women aged 0-39, the deprived and certain ethnic groups (p < 0.02).
  
  
  CONCLUSIONS
  From age 70 there is an increasing failure to operate for breast cancer. Younger women and certain ethnic groups presented with more advanced tumours. Older women had larger tumours which were otherwise of good prognosis, and this would not account for the failure to operate which may in part be related to comorbidity in this age group.
authors: The Breast Unit, William Harvey Hospital, Ashford, Kent TN24 0LZ, UK. Electronic address: bates.tom@virgin.net.
authors: T
authors: T
authors: Bates
authors: Public Health England, Knowledge and Intelligence Team (West Midlands), Birmingham B3 2PW, UK.
authors: T
authors: T
authors: Evans
authors: Public Health England, Knowledge and Intelligence Team (West Midlands), Birmingham B3 2PW, UK.
authors: C
authors: C
authors: Lagord
authors: Llandough University Hospital, Cardiff CF 64 2XX, UK.
authors: I
authors: I
authors: Monypenny
authors: Public Health England, Cancer Screening QA Reference Centre, Birmingham B3 2PW, UK.
authors: O
authors: O
authors: Kearins
authors: Public Health England, Knowledge and Intelligence Team (West Midlands), Birmingham B3 2PW, UK.
authors: G
authors: G
authors: Lawrence
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000706:statistics & numerical data; D044383:Black People / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D002277:Carcinoma / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D015897:Comorbidity; D004739:England / Q000453:epidemiology; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008408:Mastectomy / Q000706:statistics & numerical data*; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D044465:White People / Q000706:statistics & numerical data
keywords: Age factors; Breast neoplasm; Comorbidity; Data collection; Ethnic groups; Socioeconomic status; Surgery