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Breast conserving surgery versus mastectomy: the influence of comorbidities on choice of surgical operation in the Department of Defense health care system
Authors:Jing Zhou  Lindsey Enewold  Shelia H Zahm  Ismail Jatoi  Craig Shriver  William F Anderson  Diana D Jeffery  Abegail Andaya  John F Potter  Katherine A McGlynn  Kangmin Zhu
Institution:1. John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, USA;2. National Cancer Institute, NIH, Bethesda, MD, USA;3. The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA;4. General Surgery Service, Walter Reed National Military Medical Center, Bethesda, MD, USA;5. Uniformed Services University of the Health Sciences, Bethesda, MD, USA;6. Tricare Management Activity, Falls Church, VA, USA
Abstract:

Background

Studies on the effect of comorbidities on breast cancer operation have been limited and inconsistent. This study investigated whether pre-existing comorbidities influenced breast cancer surgical operation in an equal access health care system.

Methods

This study was based on linked Department of Defense cancer registry and medical claims data. The study subjects were patients diagnosed with stage I to III breast cancer during 2001 to 2007. Logistic regression was used to determine if comorbidity was associated with operation type and time between diagnosis and operation.

Results

Breast cancer patients with comorbidities were more likely to receive mastectomy (odds ratio OR] = 1.27; 95% confidence interval CI], 1.14 to 1.42) than breast conserving surgery plus radiation. Patients with comorbidities were also more likely to delay having operation than those without comorbidities (OR = 1.27; 95% CI, 1.14 to 1.41).

Conclusions

In an equal access health care system, comorbidity was associated with having a mastectomy and with a delay in undergoing operation.
Keywords:Breast cancer  Breast conserving surgery  Comorbidity  Department of Defense health system  Mastectomy  Military
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