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Agency for Healthcare Research Quality

Women's Health Highlights: Recent Findings

Program Brief

The vigorous intramural and extramural research program of the Agency for Healthcare Research and Quality (AHRQ) focuses principally on health care quality and the outcomes of health care services. Examples of AHRQ's current and completed research projects concerning conditions especially important to women are described below.

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Cardiovascular Disease
Cancer Screening and Treatment
   Breast Cancer
   Cervical Cancer
   Breast and Cervical/Ovarian Cancer
   Other Cancers
Hysterectomy and Other Treatments
Reproductive Health
Health Care Access, Quality and Costs
Violence Against Women
Pregnancy, Birth Outcomes, and Family Planning
Women and Medications
Women and Working Conditions
Other Research
Medical Expenditure Panel Survey
More Information


At the turn of the century (1900), U.S. women were most likely to die from infectious diseases and complications of pregnancy and childbirth. Today, the chronic conditions of heart disease, cancer, and stroke account for 63 percent of American women's deaths and are the leading causes of death for both women and men.

Women have a longer life expectancy than men, but they do not necessarily live those extra years in good physical and mental health. On average, women experience 3.1 years of disability at the end of life.

The Agency for Healthcare Research and Quality (AHRQ) supports research on all aspects of health care provided to women, including:

  • Enhancing the response of the health system to women's needs.
  • Understanding differences between the health care needs of women and men.
  • Understanding and eliminating disparities in health care.
  • Empowering women to make better health care decisions.

This summary presents recent findings from a cross-section of AHRQ-supported research projects on women's health.

Select for more detailed information on AHRQ's research programs, including grant announcements and grant application kits.

An asterisk (*) indicates that reprints of an intramural study or copies of other publications are available from AHRQ.

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Cardiovascular Disease

Heart disease is the number one killer of women in the United States. More than one-third of all deaths among U.S. women are due to heart disease, which usually occurs about 10 years later in life in women than in men. Heart disease mortality differs substantially among women of different races.

  • Women with atherosclerosis and high cholesterol receive less intense cholesterol management than men.

    The researchers examined cholesterol management of 243 primary care patients from one academic medical center. The patients had coronary heart disease, cerebrovascular disease, or peripheral vascular disease and high (over 130 mg/dl) low-density (bad) cholesterol. Cholesterol management by either medication adjustments or LDL monitoring occurred at 31.2 percent of women's visits and 38.5 percent of men's visits. Women were 23 percent less likely than men to have their cholesterol managed.

    Persell, Maviglia, Bates, and Ayanian, J Gen Intern Med 20:123-30, 2005 (AHRQ grant T32 HS00020)

  • Existing heart disease is undiagnosed in half of women who have a first heart attack.

    Many women who suffer a first heart attack have cardiac risk factors—such as high blood pressure, obesity, and diabetes—that have not been treated and represent missed opportunities to prevent heart problems in women. The researchers reviewed medical records of 150 women in one Minnesota county who suffered a heart attack between 1996 and 2001. Over the 10 years preceding their first heart attack, the women made a total of 8,732 outpatient visits and had 457 hospitalizations, but only 52 percent of the women had been diagnosed with heart disease. About 80 percent of women with high blood pressure were treated with antihypertensive medications, but only 28 percent of women were prescribed drug therapy for high cholesterol or lipid levels.

    Yawn, Wollan, Jacobsen, et al., J Women's Health 13(10):1087-100, 2004 (AHRQ grant HS10239).

  • Younger women with heart failure have worse quality of life than men and older women.

    Shortness of breath, fatigue, and emotional problems caused by heart failure lead to reduced quality of life, which negatively affects younger women with heart failure more than elderly women or men of any age. However, women younger than 65 in this study had more improvement in fatigue over time than older women and more improvement in emotional symptoms over time than men age 65 or older.

    Hou, Chui, Eckert, et al., Am J Crit Care 13(2):153-61, 2004 (AHRQ grant HS09822).

  • Treatment of high cholesterol in women should be based on all risk factors for heart disease.

    For women who don't have cardiovascular disease, use of cholesterol-lowering drugs to treat high cholesterol does not affect rates of death due to coronary heart disease (CHD) or total death rates. In women with known cardiovascular disease (CVD), lipid-lowering therapy can reduce CHD-related death, nonfatal heart attack, and use of coronary bypass or angioplasty, but it does not affect total mortality.

    Walsh and Pignone, JAMA 291(18):2243-52, 2004 (contract 290-97-0013).

  • Women and men with cardiovascular disease and high cholesterol may receive different levels of treatment.

    This study found that among people with CVD, men have their cholesterol measured more often, are treated more aggressively (e.g., with statins), and have lower levels of so-called "bad" cholesterol or LDL-C than women.

    Kim, Hofer, and Kerr, J., Gen Intern Med 18:854-63, 2003 (AHRQ grant HS11540).

  • Diabetes increases a woman's risk of death from coronary heart disease.

    These researchers found that compared with women who had neither diabetes nor CHD, women with only CHD had nearly double the risk of CHD-related death, while women with only diabetes had nearly four times the risk for CHD death. Those who had both CHD and diabetes were at greatest risk for CHD death. The researchers urge more aggressive treatment recommendations for women with diabetes.

    Natarajan, Liao, Cao, et al., Arch Intern Med 163:1735-40, 2003 (AHRQ grant HS10871).

  • Researchers find male-female differences in receipt of recommended cardiovascular care.

    These researchers evaluated differences between male and female patients in rates of receipt of recommended cardiovascular and diabetes care for enrollees in 10 commercial and 9 Medicare plans. In commercial plans, an average of 73.6 percent of men and 63.8 percent of women without a contraindication were prescribed a beta-blocker after a heart attack. Among the three plans with significant male-female differences, all favored men, ranging from an advantage of 23.4 to 40 percentage points.

    Bird, Fremont, Wickstrom, et al., Women's Health Issues 13:150-7, 2003 (contract 290-00-0012).

  • Lack of research on women limits usefulness of studies on CHD.

    Although CHD causes more than 250,000 deaths in women each year, much of the research in the last 20 years on CHD has either excluded women entirely or included only limited numbers of women. Two reviews focused on CHD in women were conducted recently by AHRQ's Evidence-based Practice Center (EPC) at the University of California, San Francisco/Stanford. They examined the usefulness of various lab tests and treatments for CHD in women, the role of exercise, and the effectiveness of behavioral changes in lowering CHD risk in women.

    Copies of the two reports, Results of a Systematic Review of Research on Diagnosis and Treatment of Coronary Heart Disease in Women, Evidence Report/Technology Assessment No. 80 (AHRQ Publication No. 03-E035 full report; 03-E034 summary) and Diagnosis and Treatment of Coronary Heart Disease in Women: Systematic Reviews of Evidence on Selected Topics, Evidence Report/Technology Assessment No. 81 (AHRQ Publication No. 03-E037, full report; 03-E036 summary) are available from AHRQ (contract 290-97-0013).*

  • Women with symptomatic heart failure benefit when treated with ACE inhibitors and have reduced mortality when treated with beta-blockers.

    Researchers at AHRQ's Southern California EPC examined evidence on pharmacologic management of heart failure and found that treatment with ACE inhibitors was beneficial in women, but it did not reduce mortality in women with asymptomatic left ventricular systolic dysfunction. They also found that both women and men with symptomatic heart failure have reduced mortality when treated with beta-blockers.

    Copies of Evidence Report/Technology Assessment No. 82, Pharmacologic Management of Heart Failure and Left Ventricular Systolic Dysfunction: Effect in Female, Black, and Diabetic Patients, and Cost-Effectiveness (AHRQ Publication No. 03-E044, summary and 03-E045, full report) are available from AHRQ (contract 290-97-0001).

  • Insurance status does not explain male-female differences in heart attack treatments and outcomes.

    According to this study of more than 327,000 men and women who had a heart attack between 1994 and 1997, women received fewer cardiac treatments and procedures and had worse outcomes than men, but insurance status did not explain the disparities. Regardless of insurance status, women generally were less likely than men to receive aspirin, beta-blockers, intravenous heparin, or nitrate therapies within the first 24 hours of hospital admission. Also, women were much less likely than men to undergo coronary angiography, angioplasty, or coronary bypass surgery, and they were significantly more likely than men to die in the hospital.

    Canto, Rogers, Chandra, et al., Arch Int Med 162:587-93, 2002 (AHRQ grant HS08843).

  • Women have a higher prevalence of white-coat hypertension than men.

    Researchers at AHRQ's Johns Hopkins EPC examined the available evidence on the utility of blood pressure (BP) monitoring outside of the clinic setting. Although there was some support for the use of ambulatory BP monitoring, in general, the evidence was insufficient to compare clinic BP monitoring with BP monitoring elsewhere. Evidence on BP monitoring among population subgroups was rarely stratified by race or sex. The only notable subgroup finding was a higher prevalence of white-coat hypertension in women. However, the evidence was insufficient to determine whether the risks associated with white-coat hypertension are sufficiently low to consider withholding drug therapy in this large subgroup of hypertensive patients.

    Copies of Evidence Report/Technology Assessment No. 63, Utility of Blood Pressure Monitoring Outside of the Clinic Setting (AHRQ Publication No. 03-E003, summary and 03-E004, full report) are available from AHRQ (contract 290-97-0006).*

  • Age and sex are significant predictors of death after heart attack.

    In an editorial accompanying study findings on male and female mortality rates after heart attack, this researcher notes that the interaction of age and sex remains a significant predictor of heart attack-related death, even after adjustment for demographic factors, clinical characteristics, and inpatient cardiac care. The study reported an 11 percent 2-year mortality rate for women before age 60 (vs. 7 percent for men) and a lower mortality rate for women after age 79 (46 vs. 51 percent for men).

    Ayanian, Ann Intern Med 134(3):239-41, 2001 (AHRQ grant HS09718).

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Cancer Screening and Treatment

Breast cancer continues to be the most commonly diagnosed cancer among women in the United Sates. In 2002, an estimated 203,500 U.S. women were newly diagnosed with breast cancer, and nearly 39,000 women died from the disease.

The good news is that breast cancer deaths have declined recently among white women in this country; the bad news is that over the same period, survival has decreased among black women. Although between 12 and 29 percent more white women than black women are stricken with breast cancer, black women are 28 percent more likely than white women to die from the disease. The 5-year breast cancer survival rate is 69 percent for black women, compared with 85 percent for white women.

In 2002, there were an estimated 13,000 newly diagnosed cases of invasive cervical cancer in U.S. women, and about 4,100 women died from the disease. Cervical cancer occurs most often among minority women, particularly Asian-American (Vietnamese and Korean), Alaska Native, and Hispanic women. Although deaths from cervical cancer have declined substantially over the past 30 years, the cervical cancer death rate for black women continues to be more than twice that of white women.

Women who have never had a Pap test or who have not had one for several years have a higher than average risk of developing cervical cancer. Many women still do not have regular Pap tests, particularly older women, uninsured women, minorities, poor women, and women living in rural areas. About half of the women with newly diagnosed invasive cervical cancer have not had a Pap test in the previous 5 years.

Breast Cancer

  • Study reveals shortage of radiologists at community mammography facilities.

    In a 2000-2001 survey of mammography facilities in three States, nearly half of the 45 facilities reported radiologist staffing shortages. Almost two-thirds (60 percent) of not-for-profit facilities reported shortages, compared with less than one-third (28 percent) of for-profit facilities. Waiting times for diagnostic mammography ranged from less than 1 week to 4 weeks. Forty-seven percent of facilities had a waiting time of 2 or more weeks for screening mammography, and some had waiting times of 1 to 2 months.

    Orsi, Tu, Nakano, et al., Radiology 235:391-95, 2005 (AHRQ grant HS10591).

  • Accuracy in reading mammograms is not associated with volume or years of experience.

    For this study, researchers linked nearly 500,000 screening mammograms interpreted by 124 radiologists with breast cancer outcomes data. Within 1 year of mammography, 2,402 breast cancers were identified, a rate of 5.12 per 1,000 screening mammograms. There was no significant association between accuracy and radiologists' years of interpreting mammograms or volume of reading mammograms. The researchers suggest that training prior to practice may be the most important determinant of accuracy in mammogram interpretation.

    Barlow, Chi, Carney, et al., J Natl Cancer Inst 96(24):1840-50 (AHRQ grant HS10591).

  • Clinicians should discuss use of tamoxifen to prevent breast cancer with women who are likely to benefit from it.

    These researchers surveyed 605 women (aged 40 to 69) seen in 10 general internal medicine practices in North Carolina in 2001 and found that breast cancer risks were higher for white women than for black women. Nine percent of white women and 3 percent of black women in their 40s were found to be at high risk of breast cancer, compared with 24 percent of white women and 7 percent of black women in their 50s and 53 percent of white women and 13 percent of black women in their 60s. Tamoxifen has been shown to reduce the incidence of breast cancer, but it is associated with a higher risk of endometrial cancer, blood clots, and stroke. When these risks were considered, 10 percent or fewer of white women were potentially eligible to take the drug.

    Lewis, Kinsinger, Harris, and Schwartz, Arch Intern Med 164:1897-903, 2004 (AHRQ contract 290-97-0011).

  • Study underscores the importance of involving women in breast cancer treatment decisions.

    According to this study, women who receive the breast cancer treatment they prefer have a better body image 2 years after treatment than women who do not.

    Figueiredo, Cullen, Hwang, et al., J Clin Oncol 22(19):4002-9, 2004 (AHRQ grant HS08395).

  • Obesity affects breast cancer screening rates.

    Women who are obese are less likely than non-obese white women to obtain a mammogram, a relationship not seen in black women. Among the 5,277 eligible women aged 50 to 75, 72 percent reported mammography use. White women who were obese were more likely than those who were not to report feelings of worthlessness in the preceding 30 days. Black women did not report these feelings.

    Wee, McCarthy, Davis, and Phillips, J Gen Intern Med 19:324-31, 2004 (AHRQ grant HS11683).

  • Screening mammography is less accurate in overweight and obese women.

    In this study, overweight women had a 14 percent increased risk and obese women had more than a 20 percent increased risk of having a false-positive mammogram compared with underweight and normal weight women. A false-positive rate increase of 2 percent would lead to about 200,000 additional women with false-positive mammography results entailing an additional $20 million to evaluate the results, or about $600 per false-positive result. These costs are over and above the anxiety involved for the women.

    Elmore, Carney, Abraham, et al., Arch Intern Med 164:1140-7, 2004 (AHRQ grant HS10591).

  • Most women who are diagnosed with early-stage breast cancer can choose either lumpectomy or mastectomy.

    Treatment for early-stage breast cancer usually includes either breast-conserving surgery (lumpectomy) along with radiation or mastectomy (complete removal of the affected breast). A new booklet can help women weigh the pros and cons of both options and take a more active role in the breast cancer treatment. The booklet was developed by AHRQ and the National Cancer Institute, along with other government and nongovernment partners.

    Surgery Choices for Women with Early-Stage Breast Cancer (AHRQ Publication No. PHS 04-M053) is available from AHRQ.*

  • Researchers assess quality measures for breast cancer care.

    Researchers at AHRQ's University of Ottawa EPC analyzed the scientific literature on quality measures/indicators used to assess the quality of breast cancer care in women. They found only a few evidence-based, formal quality measures for breast cancer care and conclude that it is not possible at this time to derive a meaningful overview of gaps in breast cancer care with which to inform consumers about the quality of their health care choices.

    Evidence Report/Technology Assessment No. 105, Measuring the Quality of Breast Cancer Care in Women (AHRQ Publication No. 04-E030-1, summary; and 04-E030-2, full report) is available from AHRQ.*

  • Women with certain breast tumors should not increase use of soy products to minimize menopausal symptoms.

    Chemotherapy for breast cancer, including tamoxifen, may induce or accelerate ovarian failure, resulting in severe menopausal symptoms. This review of the evidence demonstrates that soy products may stimulate breast cancer growth and interfere with tamoxifen's anti-tumor activity.

    Duffy and Cyr, J Womens Health 12(7):617-31, 2003 (AHRQ grant T32 HS00011).

  • Screening relatively health elderly women for breast cancer every 2 years is cost effective.

    This review conducted for the U.S. Preventive Services Task Force shows that for women aged 65 and over without significant health problems, breast cancer screening every 2 years reduces mortality at reasonable costs.

    Mandelblatt, Saha, Teutsch, et al., Ann Intern Med 139(10):835-42, 2003 (contract 290-97-0011).

  • Women may differ from clinicians in their opinions about the value of genetic testing for breast cancer risk.

    In this study, five focus groups that included both black and white women ages 30 to 79 discussed their opinions and knowledge about genetic testing for breast cancer risk. The women's understanding of risk, genetics, and genetic testing were affected by personal experience and beliefs and differed considerably from clinical definitions and interpretations. The women gave more emphasis to the emotional and social consequences of positive test results than to physical outcomes.

    Vuckovic, Harris, Valanis, and Stewart, Am J Obstet Gynecol 189:S48-53, 2003 (AHRQ grant T32 HS00069).

  • Use of tamoxifen to prevent breast cancer should depend on an individual woman's potential benefits and risks.

    This meta-analysis of 32 clinical trials of women (average age 55) on tamoxifen for 4.3 years showed that tamoxifen was associated with a significantly increased risk of endometrial cancer, gastrointestinal cancers, stroke, and pulmonary emboli. Conversely, tamoxifen use significantly decreased heart attack deaths and was associated with an insignificant decrease in heart attack incidence.

    Braithwaite, Chlebowski, Lau, et al., J Gen Intern Med 19:937-47, 2003 (AHRQ grant HS09796).

  • Researchers find international variations in mammography accuracy.

    Compared with community-based mammogram screening programs around the world, North American screening programs appear to interpret a higher percentage of mammograms as abnormal. However, they do not appear to detect more cancers per 1,000 screens. The variations found in this study are likely due to many factors, including characteristics of the women screened, features of the mammography exam, physicians interpreting the mammograms, and features of each country's health care system.

    Elmore, Nakano, Koepsell, et al., J Natl Cancer Inst 95(18):1384-93, 2003 (AHRQ grant HS10591).

  • Among low-income black women, those most at risk for breast cancer know the least.

    Elderly women are more likely than younger women to die from breast cancer, and black women die more often from the disease due to late diagnosis. In this study, low-income black women 65 and older underestimated their risk of getting breast cancer, and those 85 and older were the least likely to have had a mammogram or breast exam in the preceding 2 years.

    Jones, Thompson, Oster, et al., J Natl Med Assoc 95(9):791-805, 2003 (AHRQ grant HS10875).

  • Higher levels of perceived emotional support lead to increased survival in women with breast cancer.

    This study involved 145 black and 177 white women diagnosed with breast cancer in Connecticut between January 1987 and March 1989. Higher levels of perceived emotional support had a significant association with increased survival among the women who were followed for 10 years.

    Soler-Vila, Kasl, and Jones, Cancer 98:1299-308, 2003 (AHRQ grant HS06910).

  • Delayed or incomplete followup of suspected breast cancer is more common in black women than white women.

    More than one-fourth of black women who have abnormal results from mammography or clinical breast exam have not resolved the diagnosis with followup tests 6 months later. Black women with prior breast abnormalities or higher levels of cancer anxiety were about half as likely as others to followup on the abnormal results within 3 to 6 months. Delays of 3 to 6 months have been associated with lower survival rates compared with women who have shorter delays.

    Kerner, Yedida, Padgett, et al., Prev Med 37:92-101, 2003 (AHRQ grant HS08395).

  • Radiologists' access to previous mammograms improves accuracy of mammogram readings.

    When radiologists have access to women's previous mammograms, the incidence of false-positive mammogram readings is reduced by at least half. The researchers examined 1999 medical data on screening and diagnostic mammograms for 5,000 patients at a single Southern hospital.

    Kleit and Ruiz, Health Serv Res 38(4):1207-28 (AHRQ grant HS10068).

  • Benefits of adding radiation therapy to tamoxifen after lumpectomy diminish with increasing age.

    This study found that a 50-year-old postmenopausal woman with localized breast cancer who receives radiation therapy and tamoxifen after breast conserving surgery is 54 percent less likely to die from breast cancer compared with receipt of tamoxifen alone. The reduced risk for an 80-year-old woman is 42 percent.

    Punglia, Kuntz, Lee, and Recht, J Clin Oncol 21(12):2260-7, 2003 (T32 HS00020).

  • Study finds significant differences in survival for three breast cancer treatment alternatives.

    Using Medicare claims data, the researchers found highly significant differences in survival for elderly women with early stage breast cancer who underwent one of three treatments: mastectomy, breast conserving surgery with radiation, and breast conserving surgery only. These results, which are based on observational data, differ from results of randomized clinical trials.

    Hadley, Polsky, Mandelblatt, et al., Health Econ 12:171-86, 2003 (AHRQ grant HS08395).

  • Lumpectomy followed by radiation and mastectomy are equally effective for treating early-stage breast cancer.

    Two studies by researchers at Georgetown University examined the cost-effectiveness of surgical treatments for early-stage breast cancer and patients' quality of life after surgery. The first study found that giving older women with early stage breast cancer a choice of breast-conserving surgery (lumpectomy) followed by radiation treatment or mastectomy is cost effective. The second study showed that, with the exception of surgical removal of armpit lymph nodes to determine cancer spread, how older women are treated during their care, not the therapy itself, is the most important determinant of long-term quality of life.

    Polsky, Mandelblatt, Weeks, et al., J Clin Oncol 21(5):1139-46, 2003; Mandelblatt, Edge, Meropol, et al., J Clin Oncol 21(5):855-63, 2003 (AHRQ grant HS08395).

  • Reading a large volume of mammograms is only one factor influencing radiologists' accuracy.

    Radiologists who examine more than 5,000 mammograms a year are more likely to accurately interpret them than radiologists who read a low volume of mammograms. Factors other than volume also influence radiologists' accuracy in mammogram interpretation, including fear of medical malpractice, differences in the women screened, having women return to the same facility year after year, and having prior films available for comparison.

    Elmore, Miglioretti, and Carney, J Nat Cancer Inst 95(4):250-2, 2003 (AHRQ grant HS10591).

  • Patients' choice of breast cancer treatment affects health.

    Researchers surveyed 683 older women with localized breast cancer at 5 months, 1 year, and 2 years following breast cancer surgery at 1 of 29 hospitals in Massachusetts, Texas, Washington, DC, and New York. The investigators found that women aged 67 and older who participate with their doctor in choosing which treatment they receive recover faster and have a more positive short-term outlook than women who are not given a choice.

    Polsky, Keating, Weeks, et al., Med Care 40(11):1068-79, 2002 (AHRQ grant HS08395).

  • Study finds variability in the interpretation of mammograms.

    In this study, investigators examined results from 24 community radiologists' interpretations of 8,734 screening mammograms from 2,169 women over 8 years. They found wide variation in how frequently different radiologists noted masses, calcifications, and other suspicious lesions. The rate of false-positive readings ranged from 2.6 to 15.9 percent.

    Elmore, Miglioretti, Reisch, et al., J Natl Cancer Inst 94(18):1373-80, 2002 (AHRQ grant HS10591).

  • Older black women do not receive preferred breast cancer treatment.

    Data from 984 black and 849 white Medicare-insured women aged 67 years or older who had localized breast cancer were analyzed, and a subset of 732 surviving women were interviewed 3 to 4 years after treatment. Black women were 36 percent more likely than white women to receive mastectomy versus breast-conserving surgery and radiation. Further, when black women received BCS, they were 48 percent more likely than white women to not have radiotherapy.

    Mandelblatt, Kerner, Hadley, et al., Cancer 95:1401-14, 2002 (AHRQ grant HS08395).

  • Patient age and provider specialty affect the use of axillary dissection.

    Using medical records for 464 elderly women with stage 1-2 breast cancer who had breast-conserving surgery and 158 surgeon surveys, investigators examined patient, clinical, and surgeon characteristics associated with the non-use of axillary lymph node biopsy. Older age was strongly associated with decreasing odds of undergoing node biopsy. Women who were cared for by surgeons with training in surgical oncology were 60 percent less likely to undergo node dissection than women cared for by other surgeons.

    Edge, Gold, Berg, et al., Cancer 94:2534-41, 2002 (AHRQ grant HS08395).

  • Communication of treatment options enhances quality of care.

    Researchers analyzed data from 613 surgeons and their patients who had been diagnosed with localized breast cancer. According to the study results, older women who are told about treatment options by their surgeons are more likely to receive breast-conserving surgery with radiation than other types of treatment. These women also are more likely to be satisfied with the care they receive.

    Liang, Burnett, Rowland, et al., J Clin Oncol 20(4):1008-16, 2002 (AHRQ grant HS08395).

  • Removing axillary lymph nodes has a substantial negative impact on elderly women's quality of life.

    Researchers examined the quality of life of 571 elderly women who were diagnosed with stage I or II breast cancer between 1995 and 1997 from 29 hospitals in five regions. They interviewed the women at 3 months, 12 months, and 24 months after surgery about problems with arm functioning, physical and mental functioning, overall impact of breast cancer on their lives, and worry about cancer recurrence. Sixty percent of the women reported arm problems at some time in the 2 years after surgery (83 percent had axillary lymph nodes removed and 17 percent did not). Women with arm problems used significantly more physical therapy services than other women, and arm problems were the primary determinant of reduced physical and mental functioning.

    Mandelblatt, Edge, Meropol, et al., Cancer 95(12):2445-54, 2002 (AHRQ grant HS08395).

  • Mammography improves outcomes of elderly cancer patients.

    To determine the impact of mammography screening on elderly breast cancer patients, data were examined on 718 patients newly diagnosed with stage I and II disease at 29 hospitals. Researchers found that 96 percent of women with cancer diagnosed with a mammogram had stage I lesions compared with 81 percent of women diagnosed by other means.

    Kerner, Mandelblatt, Silliman, et al., Breast Cancer Res Treat 69(1):81-91, 2001 (AHRQ grant HS08395).

  • Illness burden and breast cancer therapy are correlated.

    Investigators assessed the correlations between five measures of illness burden, global health, and physical function and evaluated how each measure correlated with breast cancer treatment patterns in a group of 718 older women with early-stage breast cancer. All of the measures were significantly correlated with each other and with physical function and self-rated health.

    Mandelblatt, Bierman, Gold, et al., Health Serv Res 36(6):1085-107, 2001 (AHRQ grant HS08395).

  • Hospitals should implement care coordination mechanisms for early-stage breast cancer patients.

    Researchers interviewed 67 physicians, nurses, and support staff at six hospitals about inpatient and outpatient approaches to coordinating care for breast cancer patients. At high-coordination hospitals, 88 percent of women with breast-conserving surgery received recommended radiotherapy, and 84 percent of those with tumors larger than 1 cm received recommended systemic chemotherapy compared with 76 and 73 percent of women, respectively, at low-coordination hospitals.

    Bickell and Young, J Gen Intern Med 16:737-42, 2001 (AHRQ grant HS09844).

  • Task Force revises recommendations for mammography.

    The U.S. Preventive Services Task Force updated its recommendation by calling for screening mammography, with or without clinical breast exam, every 1 to 2 years for women 40 and over. The recommendation acknowledges some risks associated with mammography, which will lessen as women age. The strongest evidence of benefit and reduced mortality from breast cancer is among women ages 50 to 69.

    The recommendation and materials for clinicians and patients are available at

  • Outpatient mastectomies have increased over the last decade.

    Researchers reviewed hospital inpatient and outpatient discharge records for all women who were treated for cancer with a breast procedure (lumpectomy, partial mastectomy, or complete mastectomy) between 1990 and 1996 in Colorado, Maryland, New Jersey, and New York and between 1993 and 1996 in Connecticut. They found that two key factors influence whether a woman gets a complete mastectomy in the hospital or in an outpatient setting: the State where she lives and who is paying for it. For example, women in New York were more than twice as likely, and in Colorado women were nearly nine times as likely, as women in New Jersey to have an outpatient complete mastectomy. Nearly all Medicaid and Medicare enrollees were kept in the hospital after their surgery, as were 89 percent of women enrolled in HMOs.

    Case, Johantgen, and Steiner, Health Serv Res 36(5):869-84, 2001. Reprints (AHRQ Publication No. 01-R008) are available from AHRQ (Intramural).*

  • Physicians' preferences help determine treatment for older women with breast cancer.

    Researchers at Georgetown University queried a random sample of 1,000 surgeons who were given three scenarios of older women with localized breast cancer. They were asked whether they would use breast-conserving surgery (BCS) or mastectomy and whether they would use radiation therapy after BCS. Surgeons' preferences were significantly associated with self-reported practice and treatments and explained some of the variations in treatment among older women.

    Mandelblatt, Berg, Meropol, et al., Med Care 39(3):228-42, 2001 (AHRQ grant HS08395).

  • Evidence report focuses on management of breast abnormalities.

    Researchers conducted an extensive review of the evidence on management of breast abnormalities, including excisional biopsy following a stereotactic core needle biopsy, use of tamoxifen therapy, and sentinel lymph node biopsy.

    The full evidence report, Management of Specific Breast Abnormalities, Evidence Report/Technology Assessment No. 33 (AHRQ Publication No. 01-E046)* and summary (AHRQ Publication No. 01-E045),* are available from AHRQ (contract 290-97-0016).

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