The emphasis on screening mammography and minimally invasive breast biopsies has led to increasing detection of both benign and malignant breast diseases. Unfortunately, optimal management for some cancers and benign conditions remains uncertain and often relies on surgical excision. Few studies have examined population-based procedures since ambulatory surgery data are available in only selected states. This study examines variation in use of excisional breast procedures across 5 states over 7 years.
Data from the Healthcare Cost and Utilization Project (AHRQ) include discharges from community hospitals and hospital-based ambulatory surgery centers. Age-adjusted rates of lumpectomy and subtotal mastectomy are calculated across five states (CO, CT, MD, NJ, NY) and 7 years (1990-1996). States generally follow the same patterns in procedures although CO demonstrates significantly lower procedure rates for both benign and malignant disease as compared to the eastern states. In 1996, the combined rate of lumpectomy and subtotal mastectomy was 229/100,000 in CO while it was 437/100,000 in CT. The higher rates in CT represent an increase in subtotal mastectomy for both cancer and benign disease, not a tradeoff from lumpectomies. No systematic variation in procedure coding or variation in incidence of breast disease was noted.
The variation suggests that some women receive excessive surgical treatment in an effort to prevent invasive cancer that may never have developed or that others may not receive the surgery that could prevent disease. While the technology continues to promote the early detection of breast disease, the development of clear treatment standards seems to be lagging.
Learning Objectives: The participant in this session will be able to: 1. Describe trends in surgical treatment of breast disease. 2. Discuss potential sources of variation across states and disease. 3. Identify issues of concern to health policy makers
Keywords: Breast Cancer, Women's Quality Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.