title: Ageism and surgical treatment of breast cancer in Italian hospitals.
abstract: OBJECTIVE
  To determine if age is a factor influencing the type of breast cancer surgery (radical versus conservative) in Italy and to investigate the regional differences in breast cancer surgery clinical practice.
  
  
  METHODS
  Retrospective study is based on national hospital discharge records. The study draws on routinely collected data from hospital discharge records in Italy in 2010. The following exclusion criteria were applied: day hospital stays, patients younger than 17 years, males, patients without an ICD-9CM code indicating breast cancer and breast surgery, and repeated hospital admission of the same patient. Overall, 49,058 patient records were selected for the analysis.
  
  
  RESULTS
  The proportion of conservative breast cancer operations was 70.9%. A greater number of women younger than 70 had undergone a breast-conserving operation compared to older women. There were regional variations ranging from a minimum in Basilicata to a maximum in Val d'Aosta. Multivariate analysis revealed that older patients with lower clinical severity were more likely to have undergone a radical operation than younger women. In addition, radical surgery was approximately twice as likely to occur in a private hospital that performed at least 50 breast cancer operations annually than in a public hospital that performed <50 breast surgeries.
  
  
  CONCLUSIONS
  Notwithstanding increases in life expectancy and the lack of clinical evidence to support the use of age as a surrogate for co-morbid conditions and frailty, our data on breast cancer operations in Italy are consistent with the hypothesis suggesting the persistence of ageistic practice in the healthcare system.
authors.affiliation: Scientific Direction, National Institute of Health and Science on Aging-I.N.R.C.A., Ancona, Italy.
authors.forename: Mirko
authors.initials: M
authors.lastname: Di Rosa
authors.affiliation: Scientific Direction, National Institute of Health and Science on Aging-I.N.R.C.A., Ancona, Italy. carlo.chiatti@gmail.com.
authors.forename: Carlos
authors.initials: C
authors.lastname: Chiatti
authors.affiliation: Scientific Direction, National Institute of Health and Science on Aging-I.N.R.C.A., Ancona, Italy.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Rimland
authors.affiliation: Local Health Unit, Latina, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Capasso
authors.affiliation: Section of Hygiene and Public Health, Polytechnic University of the Marche Region, Ancona, Italy.
authors.forename: Valerio M
authors.initials: VM
authors.lastname: Scandali
authors.affiliation: Section of Hygiene and Public Health, Polytechnic University of the Marche Region, Ancona, Italy.
authors.forename: Emilia
authors.initials: E
authors.lastname: Prospero
authors.affiliation: Unit of Geriatric Pharmacoepidemiology, National Institute of Health and Science on Aging-I.N.R.C.A., Cosenza, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Corsonello
authors.affiliation: Scientific Direction, National Institute of Health and Science on Aging-I.N.R.C.A., Ancona, Italy.
authors.forename: Fabrizia
authors.initials: F
authors.lastname: Lattanzio
mesh_terms: D000328:Adult; D000368:Aged; D063506:Ageism; D001943:Breast Neoplasms / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy / Q000453:epidemiology; D015409:Mastectomy, Radical / Q000706:statistics & numerical data*; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data*; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: Ageism; Breast cancer surgery; Health inequalities