PATIENT, HOSPITAL, AND SURGEON FACTORS ASSOCIATED WITH BREAST-CONSERVATION SURGERY - A STATEWIDE ANALYSIS IN NORTH-CAROLINA

Objective The objective of this study was to determine the trend of br east conservation surgery (BCS) in North Carolina over a 6-year period and to identify patient, hospital, and surgeon factors associated wit h the use of BCS. Summary Background Data Despite evidence that BCS is an appropriate method of treatment for early-stage breast cancer, sur geons in the United States have been slow to adopt this treatment meth od. Methods Cases of primary breast cancer surgery in ail 157 hospital s in the state from 1988 to 1993, inclusive (N=20,760), were obtained from the Stale Medical Database Commission, Area Resource File, Americ an Hospital Association and State Board of Medical Examiner's Database s. Multiple logistic regression was used to generate odds ratios (ORs) and 95% confidence intervals (Cls) to determine factors associated wi th BCS. Results The rate of BCS doubled from 7.3% in 1988 to 14.3% in 1993, with an overall rate of 10.2% (2117/20,760). Multiple logistic r egression identified the following factors associated with BCS: patien t age younger than 50 years of age (OR=1.7, 95% CI=1.4, 2.1), patient age 50 to 69 years of age (OR=1.2, 95% CI=1.1, 1.4), private insurance (OR=1.2, 95% Cl=1.0, 1.4), hospital bed size 401+(OR=2.0, 95% Cl=1.6, 2.5), bed size 101 to 400 (OR=1.7, 95% Cl=1.3, 2.1), and surgeon grad uation from medical school since 1981 (OR=1.6, 95% Cl=1.2, 2.0).Conclu sions Rates of BCS in North Carolina are low. Least likely to have BCS were women older than 70 years of age. ithout private insurance, trea ted at small hospitals by older surgeons. To increase the use of BCS, widespread education of surgeons, other health care providers, policy makers, and the general public is warranted.