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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Contents
Introduction
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
HIV/AIDS
Homelessness
Prevention
Pregnancy, Birth Outcomes, and Family Planning
Women and Medications
Osteoporosis
Women and Working Conditions
Other Research
Medical Expenditure Panel Survey
More Information
Introduction
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.
Return to Contents
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).
Return to Contents
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
http://www.ahrq.gov/clinic/uspstf/uspsbrca.htm.
- 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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