Nonclinical factors associated with surgery received for treatment of early-stage breast cancer

Background. Women diagnosed with early breast cancer have had the opportunity to receive breast-conserving surgical treatment, which reduces the physical and psychological morbidity heretofore associated with breast removal. Methods. Nonclinical factors associated with women receiving partial mastectomies with radiation (P + R) compared with modified radical mastectomies without radiation (MOR) were examined in 2238 Black and White women diagnosed, in 1985 through 1987, with early-stage breast cancer in the metropolitan Detroit area. Results. Age at diagnosis and size of hospital were the strongest predictors of type of surgery received, with younger women (less than 55 years of age) and women treated in larger hospitals (more than 500 beds) more than twice as likely to receive P + R. Stratifying on race, age at diagnosis remained the strongest predictor for White women, followed by hospital size. Among Black women, hospital size was more strongly associated with surgery received than was age. Conclusions. Younger women and women undergoing treatment at large hospitals are more likely to receive the breast-conserving P + R. Black women treated in small hospitals appear to be particularly unlikely to receive P + R.