Physician sex and other factors associated with type of breast cancer surgery in older women

Arch Surg. 2001 Feb;136(2):185-91. doi: 10.1001/archsurg.136.2.185.


Hypothesis: Physician-related factors as well as patient characteristics may explain why women aged 65 years or older with early-stage breast cancer undergo lumpectomy less often than younger women, despite National Institutes of Health recommendations favoring lumpectomy over mastectomy.

Design: A descriptive and analytical retrospective computer-assisted telephone survey.

Setting: A population-based random sample of breast cancer survivors in Colorado, identified from the Colorado Central Cancer Registry.

Patients: Women aged 65 to 84 years when diagnosed as having stage I or II breast cancer, treated 1 to 6 years previously with mastectomy or lumpectomy, and without recurrence or second primary cancers. Among women contacted, 58% participated. Results of 198 interviews are reported.

Methods: Survey questions included patient decision-making participation and physician recommendations, sources and amount of treatment information provided by physicians, physician characteristics, and patient surgery preferences and demographic characteristics. A multivariate logistic regression model identified factors independently associated with lumpectomy.

Results: Lumpectomy was strongly associated with higher patient education, female physician sex, patient age 75 years or older, and amount of physician-provided information. The number of physician-provided information sources was associated with surgery explanations, and female physicians provided more sources of information. A physician decision or recommendation for surgery type was reported by 61% of women, of whom 93% underwent the recommended procedure. A subset of patients (13%) reported deferring the surgery decision to someone else.

Conclusions: These results suggest that better-educated and better-informed older women are more likely to undergo lumpectomy, and that physicians may influence breast cancer patients' decisions about surgery type.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Breast Neoplasms / surgery*
  • Female
  • Humans
  • Interviews as Topic
  • Logistic Models
  • Male
  • Mastectomy*
  • Mastectomy, Segmental*
  • Physicians, Women*
  • Random Allocation
  • Registries / statistics & numerical data
  • Sex Factors
  • Truth Disclosure