Minimal Increase in Use of Breast-Conserving Surgery from 1986 to 1990

Ann B. Nattinger, Mark S. Gottlieb, Raymond G. Hoffman, Alonzo P. Walker, James S. Goodwin

Research output: Contribution to journalArticlepeer-review

79 Scopus citations


Substantial geographic and hospital-based variations have been documented in the use of breast-conserving surgery (BCS) in 1986. The authors studied the patterns of adoption of this procedure from 1986 to 1990. National Medicare inpatient claims were used to study women aged 65 to 79 who underwent an operation for local or regional breast cancer in 1986 (38,679 patients) or 1990 (43,083 patients). Breast-conserving surgery was used for 5,509 (14.1%) of the Medicare patients in 1986 and 6,476 (15.0%) in 1990. The only region with an increase in BCS use from 1986 to 1990 was New England. Many hospitals had low volumes of operations, with a median of six to seven patients annually. Ten percent of the hospitals performed 55% of the conservative operations. Large hospitals, urban hospitals, and those with higher patient volumes or a cancer center were somewhat more likely to have increased use of BCS by 1990. Despite the substantial evidence supporting BCS as an alternative to mastectomy, the overall use of BCS in Medicare inpatients increased minimally from 1986 to 1990. Many patients are treated in hospitals with little experience with BCS. Hospitals using more BCS in 1986 were somewhat more likely to increase the use of BCS by 1990.

Original languageEnglish (US)
Pages (from-to)479-489
Number of pages11
JournalMedical care
Issue number5
StatePublished - May 1996


  • Breast cancer
  • Health Services Research
  • Mastectomy
  • Medicare

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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