Breast conserving surgery versus mastectomy: the influence of comorbidities on choice of surgical operation in the Department of Defense health care system

Authors

Kangmin Zhu, John P. Murtha Cancer Center, Walter Reed National Military Medical CenterFollow
Jing Zhou, National Cancer Institute
Lindsey Enewold, National Cancer Institute
Shelia H. Zham, National Cancer Institute
Ismail Jatoi, University of Texas Health Science Center at San Antonio
Craig Shriver, John P. Murtha Cancer Center, Walter Reed National Military Medical Center,
William F. Anderson, National Cancer Institute
Diana D. Jeffrey Ph.D, Tricare Management Activity
Abegail Andaya M.P.H., John P. Murtha Cancer Center, Walter Reed National Military Medical Center
John F. Potter M.D, John P. Murtha Cancer Center, Walter Reed National Military Medical Center
Katherine A. McGlynn Ph.D., M.P.H., National Cancer Institute

Date of this Version

2013

Citation

The American Journal of Surgery (2013) 206, 393-399

Comments

This article is a U.S. government work, and is not subject to copyright in the United States.

Abstract

BACKGROUND: Studies on the effect of comorbidities on breast cancer operation have been limited and inconsistent. This study investigated whether pre-existing comorbidities influenced breast cancer surgical operation in an equal access health care system. METHODS: This study was based on linked Department of Defense cancer registry and medical claims data. The study subjects were patients diagnosed with stage I to III breast cancer during 2001 to 2007. Logistic regression was used to determine if comorbidity was associated with operation type and time between diagnosis and operation. RESULTS: Breast cancer patients with comorbidities were more likely to receive mastectomy (odds ratio [OR] 5 1.27; 95% confidence interval [CI], 1.14 to 1.42) than breast conserving surgery plus radiation. Patients with comorbidities were also more likely to delay having operation than those without comorbidities (OR 5 1.27; 95% CI, 1.14 to 1.41). CONCLUSIONS: In an equal access health care system, comorbidity was associated with having a mastectomy and with a delay in undergoing operation.