Table 3.
Odds Ratios from the Fully Adjusted Model of Local Treatment Among Older Women with Early-Stage Breast Cancer SEER-Medicare, 2003–2009
| Treatment | ||||||
|---|---|---|---|---|---|---|
| Mastectomy vs. BCS+RT | BCS Only vs. BCS+RT | |||||
| AOR | 95% CI | Sig. | AOR | 95% CI | Sig. | |
| Year of diagnosis | ||||||
| 2003 | 1.00 | — | 1.00 | — | ||
| 2004 | 0.95 | 0.87–1.04 | 1.15 | 1.05–1.26 | ** | |
| 2005 | 1.01 | 0.92–1.10 | 1.22 | 1.11–1.33 | *** | |
| 2006 | 0.95 | 0.87–1.04 | 1.13 | 1.03–1.23 | * | |
| 2007 | 1.03 | 0.95–1.13 | 0.99 | 0.91–1.09 | ||
| 2008 | 1.08 | 0.99–1.18 | 1.00 | 0.91–1.09 | ||
| 2009 | 1.08 | 0.98–1.17 | 0.94 | 0.85–1.03 | ||
| Age & health | ||||||
| Age at diagnosis | ||||||
| 66–69 | 1.00 | — | 1.00 | — | ||
| 70–74 | 1.12 | 1.05–1.20 | ** | 1.12 | 1.04–1.21 | ** |
| 75–79 | 1.40 | 1.30–1.50 | *** | 1.49 | 1.38–1.61 | *** |
| 80–84 | 1.87 | 1.73–2.02 | *** | 2.39 | 2.21–2.59 | *** |
| 85–89 | 3.21 | 2.90–3.55 | *** | 5.39 | 4.89–5.94 | *** |
| ≥90 | 6.16 | 5.10–7.44 | *** | 14.13 | 11.80–16.80 | *** |
| Comorbidity score | ||||||
| 0 | 1.00 | — | 1.00 | — | ||
| 1 | 1.08 | 1.02–1.14 | * | 1.22 | 1.16–1.30 | *** |
| ≥2 | 1.14 | 1.07–1.22 | *** | 1.38 | 1.29–1.48 | *** |
| PCP visits | ||||||
| Low | 1.00 | — | 1.00 | — | ||
| High | 1.05 | 1.00–1.10 | * | 1.10 | 1.05–1.16 | *** |
| Clinical prognostic factors | ||||||
| Stage at diagnosis | ||||||
| I | 1.00 | — | 1.00 | — | ||
| II | 3.15 | 3.00–3.31 | *** | 1.26 | 1.19–1.32 | *** |
| ER status | ||||||
| Positive | 1.00 | — | 1.00 | — | ||
| Negative | 1.19 | 1.09–1.30 | *** | 1.03 | 0.93–1.13 | |
| Borderline/unknown | 1.56 | 1.24–1.96 | *** | 1.47 | 1.16–1.84 | *** |
| PR status | ||||||
| Positive | 1.00 | — | 1.00 | — | ||
| Negative | 1.12 | 1.05–1.20 | *** | 0.99 | 0.92–1.07 | |
| Borderline/unknown | 1.18 | 0.95–1.47 | 1.17 | 0.94–1.46 | ||
| Tumor size | ||||||
| 0–1 cm | 1.00 | — | 1.00 | — | ||
| <2 cm | 1.58 | 1.48–1.69 | *** | 0.96 | 0.91–1.02 | |
| 2–5 cm | 2.92 | 2.65–3.22 | *** | 1.30 | 1.17–1.44 | *** |
| >5 cm | 4.73 | 3.88–5.75 | *** | 1.47 | 1.15–1.87 | ** |
| Tumor grade | ||||||
| Well differentiated | 1.00 | — | 1.00 | — | ||
| Moderately differentiated | 1.06 | 0.99–1.12 | 0.95 | 0.89–1.01 | ||
| Poorly differentiated | 1.12 | 1.04–1.21 | ** | 0.93 | 0.86–1.00 | * |
| Undifferentiated/unknown | 1.15 | 1.03–1.28 | * | 1.40 | 1.27–1.55 | *** |
| Oncology care resources | ||||||
| Mammography screening centers | ||||||
| Low | 1.00 | — | 1.00 | — | ||
| High | 0.99 | 0.90–1.09 | 0.89 | 0.80–0.98 | * | |
| Oncology treatment centers | ||||||
| Low | 1.00 | — | 1.00 | — | ||
| High | 0.85 | 0.77–0.93 | *** | 1.04 | 0.94–1.14 | |
| Type of surgeon seen | ||||||
| General only | 1.00 | — | 1.00 | — | ||
| Oncology only | 0.78 | 0.70–0.88 | *** | 0.56 | 0.50–0.63 | *** |
| Both | 0.79 | 0.74–0.84 | *** | 0.57 | 0.53–0.60 | *** |
| Socio-demographic characteristics | ||||||
| Race | ||||||
| White | 1.00 | — | 1.00 | — | ||
| Other | 1.29 | 1.20–1.40 | *** | 1.25 | 1.15–1.36 | *** |
| Education | ||||||
| <15% college degree | 1.00 | — | 1.00 | — | ||
| ≥15% college degree | 0.75 | 0.70–0.79 | *** | 0.81 | 0.76–0.86 | *** |
| Annual income | ||||||
| ≤$35,000 | 1.00 | — | 1.00 | — | ||
| >$35,000 | 0.88 | 0.82–0.94 | *** | 0.84 | 0.78–0.90 | *** |
| Metro status | ||||||
| Nonmetro | 1.00 | — | 1.00 | — | ||
| Metro | 0.70 | 0.65–0.76 | *** | 0.73 | 0.67–0.78 | *** |
*
p < 0.05.
**
p < 0.01.
***
p < 0.001.
AOR, adjusted odds ratios; CI, confidence interval.