Ageism and surgical treatment of breast cancer in Italian hospitals
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.
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.
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.
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.
KeywordsAgeism Breast cancer surgery Health inequalities
We want to thank the “Agenzia Nazionale per i Servizi Sanitari Regionali” for providing the national database on Hospital Discharge Forms.
Compliance with ethical standards
Conflict of interest
No conflict of interest has been declared by the authors.
This article does not contain any studies with human participants or animals performed by any of the authors.
For this type of study formal consent is not required.
- 4.Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER et al (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347:1233–1241. doi: 10.1056/NEJMoa022152 CrossRefPubMedGoogle Scholar
- 9.Barchielli A, Gini R, Roti L (2004) Indicatori di qualità dell’assistenza agli anziani. Agenzia Regional Sanità, ToscanaGoogle Scholar
- 12.User guide for age discrimination benchmarking tool (2002) Department of Health, UKGoogle Scholar
- 13.Chapter 17 Cancer (2010) Achieving age equality in health and social care, NHS pratice guide. NHS, UKGoogle Scholar
- 14.A literature review of the likely costs and benefits of legislation to prohibit age discrimination in health (2007) social care and mental health services and definitions of age discrimination that might be operationalised for measurement. Centre for Policy on Ageing, UKGoogle Scholar
- 18.Chan DSY, Johnson RC, Shering SG (2010) Management of breast cancer in older women: factors which influence patients’ decision. The Open Breast. Cancer J 2:42–45Google Scholar
- 19.Siesling S, van de Poll-Franse LV, Jobsen JJ, Repelaer van Driel OJ, Voogd AC (2007) Explanatory factors for variation in the use of breast conserving surgery and radiotherapy in the Netherlands, 1990–2001. Breast (Edinburgh, Scotland) 16:606–614. doi: 10.1016/j.breast.2007.05.004 CrossRefGoogle Scholar