Age bias: A cause of underutilization of breast conservation treatment

Background. Breast conservation therapy (BCT) has been shown to result i ab out the same disease control and survival as modified radical mastectomy (M RM) for stage I and II breast cancers. Barriers to using BCT in patients wi th invasive breast cancer include "physician preference." This study was un dertaken to investigate the bias of residents with respect to breast-con, s erving procedures. Methods. Internal medicine and surgery residents were in structed about the efficacy of BCT. Subsequently, their opinions were asses sed using a questionnaire concerning recommendations for BCT versus MRM as well as breast reconstruction after MRM in similar patients. Chi square tes ts were used for statistical analysis. Results. Seventy-nine residents (54 medical, 25 surgical) participated. MRM was recommended for 38% of older (> 59 years old) versus 11 % of younger patients (< 31 years old), p < 0.01. Furthermore, breast reconstruction was recommended for 96% of younger versu s only 70% of older patients (p < 0.01). Conclusions. Residents are biased against older women in their recommendations for breast conservation and br east reconstruction. Educational efforts to decrease this age bias should b e instituted during residency.