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Mary Ann Gilligan

Publications and source records attributed to Mary Ann Gilligan.

6 recordsLinked to original sources
PubMed2007

Surgeon characteristics and variations in treatment for early-stage breast cancer.

HYPOTHESIS: Adherence to National Institutes of Health consensus statement recommendations for early-stage breast cancer will vary by surgeon characteristics. DESIGN: Secondary data analysis using the Surveillance, Epidemiology, and End Results national tumor registry linked with Medicare claims data. Logistic regression was used to analyze data on a cohort of 1045 surgeons who operated on 9449 Medicare patients with early-stage breast cancer. MAIN OUTCOME MEASURE: Care adherent to the 1990 National Institutes of Health consensus statement recommendations. RESULTS: Surgeon age and specialty were not associated with adherent care overall, nor among breast-conserving surgery or mastectomy subgroups. Patients of higher-volume surgeons were significantly more likely to undergo adherent care overall because of greater use of lymph node dissection among women who received either breast-conserving surgery or mastectomy. Patients of female surgeons and surgeons with a medical school affiliation were less likely to undergo adherent care overall, which was related to greater use of breast-conserving surgery and lesser use of lymph node dissection among patients who underwent breast-conserving surgery. CONCLUSIONS: Several surgeon characteristics are significantly associated with variations in breast cancer treatment received. These results warrant further investigation into the association between these surgeon characteristics and cancer care outcomes.

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PubMed2004

Decentralization of breast cancer surgery in the United States.

BACKGROUND: Physician volume of at least 15-30 annual breast cancer operations has been associated with higher 5-year survival rates. The authors sought to determine whether surgical volumes for breast cancer in the United States frequently reach this threshold. METHODS: The authors conducted a retrospective cohort study of 987 surgeons who operated on 8105 Medicare patients with breast cancer during 1994-1995 in 6 areas in the Surveillance, Epidemiology and End Results tumor registry. The 2-year physician volume of breast cancer operations was estimated among Medicare patients (approximating the on-average annual volumes for patients of all ages) and its association was examined with physician characteristics and with 3 measures of surgical care. RESULTS: The median 2-year Medicare volume for breast cancer surgeons was 6, and 79% of physicians performed < or = 12 operations. Approximately 50% of patients were cared for by physicians who performed < or = 12 operations over 2 years, and 10% of patients were cared for by physicians who performed > or = 30 operations. Surgeon characteristics of age, female gender, general surgery board certification, and academic affiliation were associated with modestly higher volumes of breast cancer surgery. Higher surgeon volumes were associated with higher patient receipt of breast-conserving surgery, testing for hormone receptors, and lymph node dissection during mastectomy. CONCLUSIONS: Most physicians who perform breast cancer surgery perform few annual operations in Medicare patients, and lower volumes are associated with differences in surgical processes of care. Because patients in the Medicare age group comprise almost 50% of all incident breast cancer cases, surgical volumes for patients of all ages also are likely to be low. It is likely that only approximately 10% of patients in the United States are treated by surgeons who performing at least 30 annual operations.

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PubMed2004

Menopausal hormone therapy decisions: insights from a multi-attribute model.

A multi-attribute utility (MAU) decision model for menopausal hormone replacement therapy (HRT) was developed using structured interviews (n=40) to identify decision factors, and a telephone survey (n=97) to ascertain utility scores. Utility scores for individual factors and composite scores reflecting the HRT decision were compared according to HRT use. Composite utility scores (range of -1.0 to 1.0, with higher values supporting HRT use) were 0.55, -0.27, and -0.19 for the 48 HRT users, 23 former users, and 26 never users, respectively (P<0.0001). Among HRT current users, the main factors supporting use were concerns about heart disease, osteoporosis, and symptoms of menopause. Among former users, side effects weighed heavily against use, and among never users breast cancer concerns weighed heavily against use. Linear regression methods were used to identify the utilities most predictive of current HRT use. The decision model provided insight regarding how personal expectations and values influence HRT use.

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PubMed2003

Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Women's Health Initiative Randomized Trial.

CONTEXT: The Women's Health Initiative trial of combined estrogen plus progestin was stopped early when overall health risks, including invasive breast cancer, exceeded benefits. Outstanding issues not previously addressed include characteristics of breast cancers observed among women using hormones and whether diagnosis may be influenced by hormone effects on mammography. OBJECTIVE: To determine the relationship among estrogen plus progestin use, breast cancer characteristics, and mammography recommendations. DESIGN, SETTING, AND PARTICIPANTS: Following a comprehensive breast cancer risk assessment, 16 608 postmenopausal women aged 50 to 79 years with an intact uterus were randomly assigned to receive combined conjugated equine estrogens (0.625 mg/d) plus medroxyprogesterone acetate (2.5 mg/d) or placebo from 1993 to 1998 at 40 clinical centers. Screening mammography and clinical breast examinations were performed at baseline and yearly thereafter. MAIN OUTCOME MEASURES: Breast cancer number and characteristics, and frequency of abnormal mammograms by estrogen plus progestin exposure. RESULTS: In intent-to-treat analyses, estrogen plus progestin increased total (245 vs 185 cases; hazard ratio [HR], 1.24; weighted P<.001) and invasive (199 vs 150 cases; HR, 1.24; weighted P =.003) breast cancers compared with placebo. The invasive breast cancers diagnosed in the estrogen plus progestin group were similar in histology and grade but were larger (mean [SD], 1.7 cm [1.1] vs 1.5 cm [0.9], respectively; P =.04) and were at more advanced stage (regional/metastatic 25.4% vs 16.0%, respectively; P =.04) compared with those diagnosed in the placebo group. After 1 year, the percentage of women with abnormal mammograms was substantially greater in the estrogen plus progestin group (716 [9.4%] of 7656) compared with placebo group (398 [5.4%] of 7310; P<.001), a pattern which continued for the study duration. CONCLUSIONS: Relatively short-term combined estrogen plus progestin use increases incident breast cancers, which are diagnosed at a more advanced stage compared with placebo use, and also substantially increases the percentage of women with abnormal mammograms. These results suggest estrogen plus progestin may stimulate breast cancer growth and hinder breast cancer diagnosis.

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PubMed2002

Persistent differences in sociodemographic determinants of breast conserving treatment despite overall increased adoption.

BACKGROUND: Use of breast-conserving treatment (BCT) has previously demonstrated variability by sociodemographic factors. OBJECTIVE: To determine whether variation in use of BCT by age, race, county income, county education, and population density declined between 1983 and 1996. DESIGN: Trends in use of BCT over time were modeled with logistic regression. SETTING: Surveillance, Epidemiology, and End Results national tumor registry data. PATIENTS: Population-based cohort of 158,496 women with local or regional stage breast cancer. MAIN OUTCOME MEASURE: Receipt of BCT. RESULTS: Use of BCT increased overall, and among all subgroups of age, county income, county education, population density, and race. There was no decline in age-related variation in use of BCT over time. However, older women were less likely to undergo BCT including radiotherapy (RT) and lymph node dissection (LND), and were more likely to undergo BCT omitting RT and/or LND. Variation in use of BCT by county income persisted, with women residing in poorer counties less likely to undergo BCT, whether accompanied by RT and LND. Variation in overall use of BCT by county education also persisted. Although women residing in better-educated counties were more likely to undergo BCT accompanied by RT and LND, they were not more likely to undergo BCT omitting RT, LND, or both. No decline in variation by population density occurred, with women residing in urban areas more likely to use BCT whether accompanied by RT and LND. CONCLUSIONS: Sociodemographic differences in BCT use have persisted over time. The increased overall adoption of BCT has not led to consistency in use of this treatment.

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