Skip to main content

Advertisement

SpringerLink
Log in

Patterns of Surgical Treatment for Women Diagnosed with Early Breast Cancer in Queensland

  • Breast Oncology
  • Original Papers
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Australian women with early breast cancer should be given the choice between breast-conserving surgery (BCS) or mastectomy. This is the first Australian study to report on patterns of surgical care specifically for early breast cancer at a population level.

Methods

Two population-based routine data collections were linked to obtain surgical treatment information for breast cancer cases diagnosed in 2004 in Queensland, from which we identified 1274 cases of early female breast cancer. Logistic regression was used to assess the likelihood of female breast cancer patients having mastectomy, BCS, and axillary node dissection, after adjusting for patient and hospital demographics, tumor size, and comorbidities.

Results

Three-quarters (77%) of women had BCS, 29% had a mastectomy, and 86% had dissection of the axillary lymph nodes. The likelihood of women having mastectomy was higher among women living in rural areas, those treated in public hospitals, and women who had comorbidities of anemia or heart failure. In contrast, BCS was more likely for women treated in private hospitals or hospitals with high surgical caseload. Heart failure decreased the likelihood of BCS. Having an axillary node dissection was more likely among younger women and those treated in high caseload hospitals.

Conclusion

The observed differentials in surgical treatment for early breast cancer patients suggest that access issues may have contributed to the decision-making process. Understanding the reasons why women with early breast cancer choose a certain treatment strategy should be a focus of future research.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Clinical Practice Guidelines: Management of Early Breast Cancer. National Health and Medical Research Council 2001

  2. Wickerham DL, Costantino JP, Mamounas EP, Julian TB. The landmark surgical trials of the National Surgical Adjuvant Breast and Bowel Project. World J Surg 2006;30(7):1138–46

    Article  PubMed  Google Scholar 

  3. Effects of radiotherapy and surgery in early breast cancer. An overview of the randomized trials. Early Breast Cancer Trialists’ Collaborative Group. N Engl J Med 1995;333(22):1444–55

    Article  Google Scholar 

  4. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002;347(16):1233–41

    Article  PubMed  Google Scholar 

  5. Blichert-Toft M, Rose C, Andersen JA, et al. Danish randomized trial comparing breast conservation therapy with mastectomy: six years of life-table analysis. Danish Breast Cancer Cooperative Group. J Natl Cancer Inst Monogr 1992(11):19–25

  6. Fisher B, Redmond C, Poisson R, et al. Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 1989;320(13):822–8

    Article  PubMed  CAS  Google Scholar 

  7. Veronesi U, Banfi A, Salvadori B, et al. Breast conservation is the treatment of choice in small breast cancer: long-term results of a randomized trial. Eur J Cancer 1990;26(6):668–70

    Article  PubMed  CAS  Google Scholar 

  8. Harries SA, Lawrence RN, Scrivener R, et al. A survey of the management of breast cancer in England and Wales. Ann R Coll Surg Engl 1996;78(3 (Pt 1)):197–202

    PubMed  CAS  Google Scholar 

  9. McCormick B, Yahalom J, Cox L, et al. The patients perception of her breast following radiation and limited surgery. Int J Radiat Oncol Biol Phys 1989;17(6):1299–302

    PubMed  CAS  Google Scholar 

  10. Moyer A. Psychosocial outcomes of breast-conserving surgery versus mastectomy: a meta-analytic review. Health Psychol 1997;16(3):284–98

    Article  PubMed  CAS  Google Scholar 

  11. Craft P, Primrose J, Lindner J, McManus P. Surgical management of breast cancer in Australian women in 1993: analysis of Medicare statistics. Med J Aust 1997;166(12):626–9

    PubMed  CAS  Google Scholar 

  12. Hall SE, Holman CD, Hendrie DV, Spilsbury K. Unequal access to breast-conserving surgery in Western Australia 1982–2000. ANZ J Surg 2004;74(6):413–9

    Article  PubMed  Google Scholar 

  13. Kricker A, Haskill J, Armstrong BK. Breast conservation, mastectomy and axillary surgery in New South Wales women in 1992 and 1995. Br J Cancer 2001;85(5):668–73

    Article  PubMed  CAS  Google Scholar 

  14. Mitchell KJ, Fritschi L, Reid A, et al. Rural-urban differences in the presentation, management and survival of breast cancer in Western Australia. Breast 2006;15(6):769–76

    Article  PubMed  CAS  Google Scholar 

  15. Koshy A, Buckingham JM, Zhang Y, et al. Surgical management of invasive breast cancer: a 5-year prospective study of treatment in the Australian Capital Territory and South-Eastern New South Wales. ANZ J Surg 2005;75(9):757–61

    Article  PubMed  Google Scholar 

  16. Strong K. Health in Rural and Remote Australia: the First Report of the Australian Institute of Health and Welfare on Rural Health. Canberra: Australian Institute of Health and Welfare, 1998

    Google Scholar 

  17. Furnival C. Access to breast-conserving treatment: are surgeons responsible? ANZ J Surg 2004;74(6):402–3

    Article  PubMed  Google Scholar 

  18. Enger SM, Thwin SS, Buist DS, et al. Breast cancer treatment of older women in integrated health care settings. J Clin Oncol 2006;24(27):4377–83

    Article  PubMed  Google Scholar 

  19. Mandelblatt JS, Hadley J, Kerner JF, et al. Patterns of breast carcinoma treatment in older women: patient preference and clinical and physical influences. Cancer 2000;89(3):561–73

    Article  PubMed  CAS  Google Scholar 

  20. Yancik R, Ries LG, Yates JW. Breast cancer in aging women. A population-based study of contrasts in stage, surgery, and survival. Cancer 1989;63(5):976–81

    Article  PubMed  CAS  Google Scholar 

  21. Wanebo HJ, Cole B, Chung M, et al. Is surgical management compromised in elderly patients with breast cancer? Ann Surg 1997;225(5):579–86; discussion 586–9

    Article  PubMed  CAS  Google Scholar 

  22. Lazovich DA, White E, Thomas DB, Moe RE. Underutilization of breast-conserving surgery and radiation therapy among women with stage I or II breast cancer. JAMA 1991;266(24):3433–8

    Article  PubMed  CAS  Google Scholar 

  23. August D, Rea T, Sondak V. Age-related differences in breast cancer treatment. Ann Surg Oncol 1994;1(1):45–52

    Article  PubMed  CAS  Google Scholar 

  24. Guadagnoli E, Shapiro CL, Weeks JC, et al. The quality of care for treatment of early stage breast carcinoma: is it consistent with national guidelines? Cancer 1998;83(2):302–9

    Article  PubMed  CAS  Google Scholar 

  25. Hurria A, Leung D, Trainor K, et al. Factors influencing treatment patterns of breast cancer patients age 75 and older. Crit Rev Oncol Hematol 2003;46(2):121–6

    Article  PubMed  Google Scholar 

  26. Cuncins-Hearn AV, Boult M, Babidge W, et al. National breast cancer audit: overview of invasive breast cancer management. ANZ J Surg 2006;76(8):745–50

    Article  PubMed  Google Scholar 

  27. Clinical Practice Guidelines Management of Advanced Breast Cancer. National Health and Medical Research Council 2001

  28. Martin MA, Meyricke R, O’Neill T, Roberts S. Breast-conserving surgery versus mastectomy for survival from breast cancer: the Western Australian experience. Ann Surg Oncol 2007;14(1):157–64

    Article  PubMed  Google Scholar 

  29. Ingram DM, McEvoy SP, Byrne MJ, et al. Surgical caseload and outcomes for women with invasive breast cancer treated in Western Australia. Breast 2005;14(1):11–7

    Article  PubMed  CAS  Google Scholar 

  30. Rural, Regional and Remote Health: A Guide to Remoteness Classifications. Australian Institute of Health and Welfare 2004

  31. Bach PB, Cramer LD, Schrag D, et al. The influence of hospital volume on survival after resection for lung cancer. N Engl J Med 2001;345(3):181–8

    Article  PubMed  CAS  Google Scholar 

  32. Holmes CE, Muss HB. Diagnosis and treatment of breast cancer in the elderly. CA Cancer J Clin 2003;53(4):227–44

    Article  PubMed  Google Scholar 

  33. Stata Corporation. Stata statistical software version 9.2. College Station, TX: Stata Corporation

  34. Diab SG, Elledge RM, Clark GM. Tumor characteristics and clinical outcome of elderly women with breast cancer. J Natl Cancer Inst 2000;92(7):550–6

    Article  PubMed  CAS  Google Scholar 

  35. Dunnwald LK, Rossing MA, Li CI. Hormone receptor status, tumor characteristics, and prognosis: a prospective cohort of breast cancer patients. Breast Cancer Res 2007;9(1):R6

    Article  PubMed  CAS  Google Scholar 

  36. Kenny P, King MT, Shiell A, et al. Early stage breast cancer: costs and quality of life one year after treatment by mastectomy or conservative surgery and radiation therapy. Breast 2000;9(1):37–44

    Article  PubMed  CAS  Google Scholar 

  37. Newcomb PA, Carbone PP. Cancer treatment and age: patient perspectives. J Natl Cancer Inst 1993;85(19):1580–4

    Article  PubMed  CAS  Google Scholar 

  38. Ohsumi S, Shimozuma K, Kuroi K, et al. Quality of life of breast cancer patients and types of surgery for breast cancer—current status and unresolved issues. Breast Cancer 2007;14(1):66–73

    Article  PubMed  Google Scholar 

  39. Mastaglia B, Kristjanson LJ. Factors influencing women’s decisions for choice of surgery for Stage I and Stage II breast cancer in Western Australia. J Adv Nurs 2001;35(6):836–47

    Article  PubMed  CAS  Google Scholar 

  40. Nattinger AB, Kneusel RT, Hoffmann RG, Gilligan MA. Relationship of distance from a radiotherapy facility and initial breast cancer treatment. J Natl Cancer Inst 2001;93(17):1344–6

    Article  PubMed  CAS  Google Scholar 

  41. Schroen AT, Brenin DR, Kelly MD, et al. Impact of patient distance to radiation therapy on mastectomy use in early-stage breast cancer patients. J Clin Oncol 2005;23(28):7074–80

    Article  PubMed  Google Scholar 

  42. Furnival CM. Breast cancer in rural Australia. Med J Aust 1997;166(1):25–6

    PubMed  CAS  Google Scholar 

  43. Wei JP, Sherry RM, Baisden BL, et al. Prospective hospital-based survey of attitudes of Southern women toward surgical treatment of breast cancer. Ann Surg Oncol 1995;2(4):360–4

    Article  PubMed  CAS  Google Scholar 

  44. Fontana V, Castro T, Polynice A. Preferences of healthy inner city women and the surgical treatment of early stage breast cancer. Am Surg 2007;73(3):215–21

    PubMed  Google Scholar 

Download references

Acknowledgments

Funding for the study was granted to The Cancer Council Queensland by the Golden Casket Foundation. The Queensland Cancer Registry, which is managed under contract to Queensland Health, supplied the data on invasive breast cancer in 2004. Queensland Health made available a linked file of procedures recorded in the Queensland Hospital Admitted Patients Data Collection for women with invasive breast cancer in 2004. The authors wish to thank Dr. Euan Walpole and Associate Professor Joanne Aitken for their assistance with this project. Lin Fritschi was supported by an NHMRC Career Development Award.

Author information

Authors and Affiliations

  1. Viertel Centre for Research in Cancer Control, The Cancer Council Queensland, Spring Hill, Queensland, Australia

    Bridie Thompson BSc & Peter Baade PhD

  2. School of Population Health, The University of Queensland, Herston, Queensland, Australia

    Michael Coory PhD

  3. School of Public Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia

    Philippe Carrière MD

  4. Western Australian Institute for Medical Research, The University of Western Australia, Nedlands, Western Australia

    Lin Fritschi PhD

Authors
  1. Bridie Thompson BSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter Baade PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Coory PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Philippe Carrière MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lin Fritschi PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bridie Thompson BSc.

Additional information

Published by Springer Science+Business Media, Inc. © 2007 The Society of Surgical Oncology, Inc.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thompson, B., Baade, P., Coory, M. et al. Patterns of Surgical Treatment for Women Diagnosed with Early Breast Cancer in Queensland. Ann Surg Oncol 15, 443–451 (2008). https://doi.org/10.1245/s10434-007-9584-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-007-9584-4

Keywords

Search

Navigation