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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

Bates, Tom, Evans, T, Lagord, C., Monypenny, I, Kearins, O., Lawrence, G (2014) 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. European Journal of Surgical Oncology, 40 (10). pp. 1230-1236. ISSN 1532-2157. (doi:10.1016/j.ejso.2014.06.001) (KAR id:47048)

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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 < 0.001). Good prognosis tumours were more likely to be screen-detected, and less likely in women aged 0–39, the deprived and certain ethnic groups (p < 0.02).

Conclusions

From age 70 there is an increasing failure to operate for breast cancer. Younger women and certain ethnic groups presented with more advanced tumours. Older women had larger tumours which were otherwise of good prognosis, and this would not account for the failure to operate which may in part be related to comorbidity in this age group.

Item Type: Article
DOI/Identification number: 10.1016/j.ejso.2014.06.001
Subjects: R Medicine > RD Surgery
Divisions: Divisions > Directorate of Education > School of Education
Depositing User: Bates Tom
Date Deposited: 03 Feb 2015 16:50 UTC
Last Modified: 29 Sep 2021 15:00 UTC
Resource URI: https://kar.kent.ac.uk/id/eprint/47048 (The current URI for this page, for reference purposes)
Bates, Tom: https://orcid.org/0000-0001-5554-1945
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