The Influence of Age on the Breast Surgery Decision-Making Process
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Mastectomy rates have been assumed to be a function of physician recommendations, although they correlate with patient involvement in decision making. The influence of age on the decision-making process and treatment choice is poorly described.
All women with ductal carcinoma in situ (DCIS) and a random sample with invasive breast cancer were identified from two Surveillance Epidemiology and End Results (SEER) program registries and surveyed 6 months postoperatively. Women older than 79 years with noninvasive or localized invasive breast cancer diagnosed in 2002 were included. Women with breast-conserving therapy (BCT) contraindications were excluded. Women were questioned about involvement in surgical decision-making, inquiring if this decision was patient-based, surgeon-based, or shared. Knowledge and concerns were assessed.
The response rate was 77.0%. There were 1,259 patients who met the study eligibility criteria and age data was available for 1,131. Median patient age was 59.9 years. The frequency of patient-based decisions did not vary with age (p = 0.20), but older women had less knowledge for decision making. The mastectomy rate overall was 19.7%, with no differences in mastectomy choice by age (p = 0.18). In logistic regression for the likelihood of undergoing mastectomy, patient involvement (p < 0.0001), larger tumor size (p < 0.0001), lower education (p = 0.0002), number of surgeons consulted (p = 0.0005), and nonwhite race origin (p = 0.011) were significant predictors, while age, invasion, and comorbidities were not significant.
Older women participate equally in breast cancer surgical decision making and are equally likely to select mastectomy, but use less knowledge to make the decision. The impact of education and ethnic origin on mastectomy use indicates the need for improved educational strategies for these groups.
KeywordsBreast neoplasms Carcinoma Decision making Mastectomy Segmental mastectomy Patient participation
Funded by a grant from the National Cancer Institute (R01CA8837-AI).
- 2.Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002;347:1227–32Google Scholar
- 4.National Cancer Institute. 1973–2001 SEER Public Use DataGoogle Scholar
- 8.Surveillance Epidemiology and End Results (SEER) Program. SEER Fast Stats - Breast Cancer, Incidence. In: Institute NC, vol. 2007Google Scholar
- 13.Dillman DA. Mail and telephone surveys. New York: Wiley; 1978Google Scholar
- 18.Hewitt ME, Simone JV. Institute of Medicine and Commission on Life Sciences, National Research Council report for the National Cancer Policy Board: Ensuring quality cancer care. Washington, D.C.: National Academy Press; 1999. ix, p 246Google Scholar
- 27.Collins D, Sepucha K, O’Connor A, et al. Can women with early stage breast cancer make an informed decision for mastectomy? Breast Cancer Res Treat 2006;100:S118Google Scholar