Patient, Hospital, and Surgeon Factors Associated with Breast Conservation Surgery

TLDR

The study aimed to assess trends in breast conservation surgery in North Carolina from 1988 to 1993 and to identify patient, hospital, and surgeon factors influencing its use. Data from 20,760 primary breast cancer surgeries across 157 hospitals were analyzed using multivariable logistic regression to estimate odds ratios for factors associated with BCS. BCS use rose from 7.3% to 14.3% (overall 10.2%) and was more likely among women under 70, those with private insurance, patients treated at larger hospitals, and surgeons who graduated after 1981; older women, uninsured patients, small‑hospital cases, and older surgeons were least likely to receive BCS, underscoring the need for broader education to increase its adoption.

Abstract

The objective of this study was to determine the trend of breast conservation surgery (BCS) in North Carolina over a 6-year period and to identify patient, hospital, and surgeon factors associated with the use of BCS.Despite evidence that BCS is an appropriate method of treatment for early stage breast cancer, surgeons in the United States have been slow to adopt this treatment method.Cases of primary breast cancer surgery in all 157 hospitals in the state from 1988 to 1993, inclusive (N = 20,760), were obtained from the State Medical Database Commission, Area Resource File, American Hospital Association and State Board of Medical Examiner's Databases. Multiple logistic regression was used to generate odds ratios (ORs) and 95% confidence intervals (CIs) to determine factors associated with BCS.The rate of BCS doubled from 7.3% in 1988 to 14.3% in 1993, with an overall rate of 10.2% (2117/ 20.760). Multiple logistic regression identified the following factors associated with BCS: patient age younger than 50 years of age (OR = 1.7, 95% CI = 1.4, 2.1), patient age 50 to 69 years of age (OR = 1.2, 95% CI = 1.1, 1.4), private insurance (OR = 1.2, 95% CI = 1.0, 1.4), hospital bed size 401+(OR = 2.0, 95% CI = 1.6, 2.5), bed size 101 to 400 (OR = 1.7, 95% CI = 1.3, 2.1), and surgeon graduation from medical school since 1981 (OR = 1.6, 95% CI = 1.2, 2.0).Rates of BCS in North Carolina are low. Least likely to have BCS were women older than 70 years of age, without private insurance, treated at small hospitals by older surgeons. To increase the use of BCS, widespread education of surgeons, other health care providers, policy makers, and the general public is warranted.