A population based study of variations in operation rates for breast cancer, of comorbidity and prognosis at diagnosis: Failure to operate for early breast cancer in older women

Abstract Background Older women are less likely to have surgery for operable breast cancer. This population-based study examines operation rates by age and identifies groups which present with early or late disease. Methods 37 000 cancer registrations for 2007 were combined with Hospital Episode Sta...

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Published in:	European journal of surgical oncology 2014-10, Vol.40 (10), p.1230-1236
Main Authors:	Bates, T, Evans, T, Lagord, C, Monypenny, I, Kearins, O, Lawrence, G
Format:	Article
Language:	eng
Subjects:	Adult African Continental Ancestry Group - statistics & numerical data Age Factors Aged Aged, 80 and over Asian Continental Ancestry Group - statistics & numerical data Breast neoplasm Breast Neoplasms - epidemiology Breast Neoplasms - pathology Breast Neoplasms - surgery Carcinoma - epidemiology Carcinoma - pathology Carcinoma - surgery Cohort Studies Comorbidity Data collection England - epidemiology Ethnic groups Ethnic Groups - statistics & numerical data European Continental Ancestry Group - statistics & numerical data Female Healthcare Disparities - statistics & numerical data Hematology, Oncology and Palliative Medicine Humans Mastectomy - statistics & numerical data Middle Aged Neoplasm Staging Prognosis Retrospective Studies Socioeconomic Factors Socioeconomic status Surgery
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Summary:	Abstract Background Older women are less likely to have surgery for operable breast cancer. This population-based study examines operation rates by age and identifies groups which present with early or late disease. Methods 37 000 cancer registrations for 2007 were combined with Hospital Episode Statistics comorbidity data for England. Operation rates were examined by age, ethnicity, deprivation, comorbidity, screen-detection, tumour size, grade and nodal status. Early and late presentation were correlated with Nottingham Prognostic Index (NPI) groups and tumour size. Results The proportion of women not having surgery increased from 7–10% at ages 35–69 to 82% from age 90. From age 70, the proportion not having surgery rose by an average of 3.1% per year of age. Women with a Charlson Comorbidity Index score of ≥1 (which increased with age), with tumours >50 mm or who were node positive, were less likely to have surgery. Although women aged 70–79 were more likely to have larger tumours, their tumours were also more likely to have an excellent or good NPI ( p
ISSN:	0748-7983 1532-2157