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Physician Sex and Other Factors Associated With Type of Breast Cancer Surgery in Older Women
Elizabeth M. Cyran, MD,MSPH;
Lori A. Crane, PhD,MPH;
Laura Palmer, BS
Arch Surg. 2001;136:185-191.
Hypothesis Physician-related factors as well as patient characteristics may explain why women aged 65 years or older with early-stage breast cancer undergo lumpectomy less often than younger women, despite National Institutes of Health recommendations favoring lumpectomy over mastectomy.
Design A descriptive and analytical retrospective computer-assisted telephone survey.
Setting A population-based random sample of breast cancer survivors in Colorado, identified from the Colorado Central Cancer Registry.
Patients Women aged 65 to 84 years when diagnosed as having stage I or II breast cancer, treated 1 to 6 years previously with mastectomy or lumpectomy, and without recurrence or second primary cancers. Among women contacted, 58% participated. Results of 198 interviews are reported.
Methods Survey questions included patient decision-making participation and physician recommendations, sources and amount of treatment information provided by physicians, physician characteristics, and patient surgery preferences and demographic characteristics. A multivariate logistic regression model identified factors independently associated with lumpectomy.
Results Lumpectomy was strongly associated with higher patient education, female physician sex, patient age 75 years or older, and amount of physician-provided information. The number of physician-provided information sources was associated with surgery explanations, and female physicians provided more sources of information. A physician decision or recommendation for surgery type was reported by 61% of women, of whom 93% underwent the recommended procedure. A subset of patients (13%) reported deferring the surgery decision to someone else.
Conclusions These results suggest that better-educated and better-informed older women are more likely to undergo lumpectomy, and that physicians may influence breast cancer patients' decisions about surgery type.
From the Departments of Medicine (Dr Cyran) and Preventive Medicine and Biometrics (Dr Crane), University of Colorado Health Sciences Center, and the Colorado Foundation for Medical Care (Ms Palmer), Denver.
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