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Age bias: a cause of underutilization of breast conservation treatment
A K Madan1, S Aliabadi-Wahle, D J Beech
1Department of Surgery, Tulane University, School of Medicine, New Orleans, Louisiana, USA.
Background:
Breast conservation therapy (BCT) has been shown to result i about the same disease control and survival as modified radical mastectomy (MRM) for stage I and II breast cancers. Barriers to using BCT in patients with invasive breast cancer include "physician preference." This study was undertaken to investigate the bias of residents with respect to breast-conserving procedures.
Methods:
Internal medicine and surgery residents were instructed about the efficacy of BCT. Subsequently, their opinions were assessed using a questionnaire concerning recommendations for BCT versus MRM as well as breast reconstruction after MRM in similar patients. Chi square tests were used for statistical analysis.
Results:
Seventy-nine residents (54 medical, 25 surgical) participated. MRM was recommended for 38% of older (> 59 years old) versus 11% of younger patients (< 31 years old), p < 0.01. Furthermore, breast reconstruction was recommended for 96% of younger versus only 70% of older patients (p < 0.01).
Conclusions:
Residents are biased against older women in their recommendations for breast conservation and breast reconstruction. Educational efforts to decrease this age bias should be instituted during residency.
