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.