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Study Finds Use of Breast-Conserving Surgery in U.S. Varies Among Hospitals, Geographical Regions (dateline February 7, 2001)


According to a new report, eligible women at the nation’s top hospitals are more likely to receive breast-conserving surgery (also called lumpectomy) as their primary course of treatment than women at community hospitals. The study also found that breast cancer treatment varies depending on geographical location, race, and insurance coverage. For example, women covered by Medicaid may be less likely to receive immediate breast reconstruction after mastectomy (breast removal) than women who are not on Medicaid.

The study, which was released by the Solucient Leadership Institute, compared breast cancer patients’ likelihood of receiving breast-conserving surgery (compared to mastectomy) by hospital region, location, bed size, teaching status, and ranking among the company’s Top 100 Hospitals data. The study also investigated the use of radiation therapy following lumpectomy and the use of immediate breast reconstruction following mastectomy.

Study results:

  • Compared to patients in the Northeastern United States, women in the South are 21% less likely to receive breast-conserving surgery, and women in the West are 17% less likely to receive breast-conserving surgery.
  • 46% of Hispanic women undergo breast-conserving surgery, compared to 47.5% of African-American women, 48.5% of Asian Americans, and 51.1% of White women.
  • Women insured by Medicaid are 69% less likely than privately insured patients to receive immediate breast reconstruction following mastectomy.
  • Immediate reconstructive surgery following mastectomy is more common in top-performing hospitals and teaching hospitals compared to community hospitals.
  • When studying radiation following breast-conserving surgery, patients are most likely to undergo radiation therapy in top performing hospitals, as well as in hospitals in the Western region; moreover, younger women are more likely than older patients to receive post-lumpectomy radiation.

*source: Solucient Leadership Institute

While the likelihood that breast cancer will recur is higher with breast-conserving surgery than with mastectomy, studies have shown that both surgeries are effective for women with early-stage breast cancer. For example, a 10-year study found no difference in the long-term survival among women with ductal carcinoma in situ (an early stage breast cancer), regardless of whether the women had lumpectomy or mastectomy.

Rates of Breast-Conserving Surgery by Region
Northeast
North Central
West
South		 60.5%
51.1%
50.2%
48.0%

*source: Solucient Leadership Institute

In contrast to the report released by the Solucient Leadership Institute, a study presented at the annual meeting of the Radiological Society of North America (RSNA) in Chicago this past November found that the type of surgery a breast cancer patient receives depends largely on the choice of her surgeon, not on geographical location. Radiation oncologist Lillian Rinker, MD and her colleagues found that in their study, only 47% of patients with small breast cancers (four centimeters or less in diameter) underwent lumpectomy, even though all women were eligible for the procedure.

In the Solucient Leadership Institute study, researchers also found that younger patients were more likely to receive immediate breast reconstruction following mastectomy than older patients. The decision to have immediate breast reconstruction (at the same time as mastectomy) should be made carefully, with consideration to both medical and emotional factors. Advantages to immediate breast reconstruction include: not waking up to the shock of "losing" a breast, the possibility of avoiding additional reconstructive surgery, and having the plastic surgeon and cancer surgeon work together during the surgery. Disadvantages to immediate breast reconstruction include: the emotional burden of making reconstructive decisions while also dealing with the diagnosis and treatment of breast cancer and possible complications with future breast cancer treatments (such as chemotherapy or radiation).

Rates of Immediate Reconstructive Surgery Following Mastectomy by Age Group
Ages 18-39
Ages 40-59
Ages 60-64
Ages 65-69
Ages 70-74
Over Age 75		 29.7%
24.4%
9.8%
5.3%
2.2%
0.6%

source: Solucient Leadership Institute

While it is important not to delay action, a woman diagnosed with breast cancer should have a sufficient amount of time to discuss her treatment options with her physician and family and make an informed decision on how best to proceed with treating the disease. A period of a few weeks or even a month is not unusual in preparing for definitive surgery (lumpectomy or mastectomy) and planning subsequent therapy (such as chemotherapy or radiation) and reconstruction.

Additional Resources and References