Underutilization of breast-conserving surgery and radiation therapy among women with stage I or II breast cancer

Article Abstract:

Traditionally, breast cancer was treated using the Halsted mastectomy, surgical removal of the breast, underlying chest muscles, and axillary contents. Recent research has indicated that among women with breast cancer in its early stages, conservative treatment involving only excision of the tumor and surrounding tissue followed by radiation therapy is preferable. In 1990, the National Institutes of Health (NIH) recommended conservative treatment, or breast-conserving surgery (BCS), for early-stage breast cancer. This study examined the use of BCS in women with early-stage breast cancer. Treatment data were obtained for women residing in the Seattle area who had either stage I or II breast cancer and were treated between 1983 and 1989. BCS was performed on 33.7 percent of the women. Only 25.7 percent of the women with stage II disease underwent BCS, while 42.6 percent of the women with stage I disease had BCS. BCS was most widely used in 1985, a significant difference from 1983 and 1984. Slight declines in use of BCS occurred after the peak in 1985. BCS was more likely to be used when the patients were younger, more affluent, or more educated. Between 12 and 16 percent of the patients treated with BCS were not given postoperative radiation therapy. Women not given radiation therapy tended to be older, to have stage II disease, or to live in an area without radiation therapy facilities. These results indicate that BCS (and in some cases radiation therapy) was underutilized as a treatment for early-stage breast cancer in this population. In addition, the factors associated with the use (and nonuse) of BCS do not reflect the criteria established by the National Institutes of health. (Consumer Summary produced by Reliance Medical Information, Inc.)

Standards, Surgery, United States. National Institutes of Health, Breast, Breast surgery, Lumpectomy

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Stage at Diagnosis and Treatment Patterns Among Older Women With Breast Cancer: An HMO and Fee-for-Service Comparison

Article Abstract:

There may be widespread variations in the care received by breast cancer patients depending on whether they are covered by fee-for-service (FFS) or are a member of an HMO. Researchers analyzed the care received by Medicare beneficiaries diagnosed with breast cancer between 1988 and 1993. HMO members were more likely to be diagnosed in the early stages of the disease compared with FFS patients. Overall, FFS patients were just as likely to receive breast-conserving surgery or radiation treatment as HMO patients. However, treatment patterns varied widely when individual plans were analyzed.

Health maintenance organizations, Aged patients, Elderly patients

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