Feature Story

Physician preference plays a role in breast cancer treatment for women age 65 and older

Nearly 50 percent of new cases of breast cancer and almost two-thirds of the deaths from this disease occur among women 65 years of age or older. Doctors vary greatly in how they treat localized breast cancer, and more than clinical factors influence their treatment decisions. A recent study reveals that whether an older woman receives breast-conserving surgery (BCS) or mastectomy (MST) depends in part on her doctor's treatment preference. With support from the Agency for Healthcare Research and Quality (HS08395), Jeanne S. Mandelblatt, M.D., M.P.H., of the Georgetown University School of Medicine, and her colleagues surveyed a random sample of 1,000 surgeons treating Medicare beneficiaries in fee-for-service settings.

The researchers asked the surgeons whether they would use BCS or MST for two clinical scenarios involving older women with localized breast cancer and whether they would use radiation therapy after BCS in another scenario. There was no "right" answer for either scenario, since the best treatment was a clinical "toss-up." Surgeons practicing in areas with the highest BCS fees were nearly nine times as likely to choose BCS for the scenarios as surgeons in areas with the lowest fees. After controlling for other factors, surgeons with the strongest beliefs in patient participation in treatment decisions were nearly six times as likely to choose BCS as surgeons with the weakest belief in patient participation.

Male surgeons were more likely to favor MST over BCS than female surgeons. Older and male surgeons were less likely than young or female surgeons to choose radiation therapy after BCS, which is recommended by the National Cancer Institute, but not often used in the elderly. Finally, surgeons' treatment preferences in the scenarios were significantly associated with self-reported practice and actual treatments for localized breast cancer. The researchers conclude that surgeons' treatment preferences explain some of the observed variations in breast cancer treatment patterns among older women.

See "Measuring and predicting surgeons' practice styles for breast cancer treatment in older women," by Dr. Mandelblatt, Christine D. Berg, M.D., Neal J. Meropol, M.D., and others, in the March 2001 Medical Care 39(3), pp. 228-242.

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