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.

Trends in conserving treatment of invasive carcinoma of the breast in females.

This population-based study presents trends in the treatment of node-negative invasive carcinoma of the breast in females during the 1980s in the Detroit metropolitan area. It was done to determine whether or not there has been a significant shift toward conservation of the breast from 1980 to 1987. Trend analyses of surgical treatment, tumor size, node status, year of diagnosis, age and race were performed for 13,217 patients drawn from the Metropolitan Detroit Cancer Surveillance System. A significant increase in the use of conserving the breast was observed, with younger women receiving this treatment option more often than older women. Implications for a continuing shift in the biologic findings and treatment of carcinoma of the breast are discussed.

Racial differences in the early detection of breast cancer in metropolitan Detroit, 1978 to 1987.

This population-based study presents trends in stage at diagnosis of invasive female breast cancer during the decade from 1978 to 1987 in the Detroit metropolitan area. Its purpose is to determine whether there has been an increase in early breast cancers: those that are smaller than 2 cm at diagnosis and have no axillary lymph node involvement. Trend analyses of tumor size, node status, year of diagnosis, age, and race were performed for 17,216 incident cases drawn from the Metropolitan Detroit Cancer Surveillance System (MDCSS). Although trends toward earlier diagnosis of breast cancer are observed, less improvement is seen for black women than white women in the presentation of breast cancer at smaller, node-free stages. Implications for breast cancer screening are discussed.

Summary measures of occupational history: a comparison of latest occupation and industry with usual occupation and industry.

The utility of using latest occupational information as a summary of work history is assessed by comparing it to usual occupation and industry. We analyzed 5,734 complete occupational histories obtained by telephone interview as part of an ongoing occupational cancer surveillance study. Of these, 73.6 per cent reported the same usual occupation as latest occupation and 76.6 per cent the same usual industry as latest industry. Differences in match rates by race and sex, occupation and industry titles and categories suggest that bias may result in studies using latest occupation or industry as a summary measure of occupational exposures.