Breast Cancer Practice Patterns at VA Hospitals: Implications for Future Research

  • Denise M. Hynes
  • Edward HinesJr.
  • Lori A. Bastian
Part of the Cancer Treatment and Research book series (CTAR, volume 97)


Cancer incidence among women veterans has been estimated to be twice that of the general population.[1] Current estimates that one out of nine American women will develop breast cancer in their lifetime [2], translates into an estimated 133,000 veterans who will develop breast cancer. Currently there are over 1.2 million women veterans in the United States and approximately 10% of active duty military officers and enlisted personnel are women.[1,3] One out of every ten women veterans have used inpatient services at a VA hospital since leaving the service.[3] In particular, the use of breast cancer screening and treatment services by female veterans has been substantial and is increasing steadily. In Fiscal Year (FY) 1994, over 1,300 women had a breast cancer-related admission to a VA hospital.[4] With the current breast cancer incidence estimates, the aging of the women veteran population and the increasing demand for women ’s health care services at VA hospitals — and for breast cancer care in particular — practice patterns at VA hospitals can have dramatic impacts on the health of women veterans.


Breast Cancer Breast Cancer Screening Practice Pattern Hormone Receptor Status Breast Biopsy 
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  1. 1.
    Louis Harris and Associates. Survey of Female Veterans: A Study of Needs, Attitudes and Experiences of Women Veterans. 1991.Google Scholar
  2. 2.
    American Cancer Society (ACS). Cancer Facts & Figures, 1996. American Cancer Society, 1996.Google Scholar
  3. 3.
    U.S. Department of Veterans Affairs (DVA) Veteran Population estimates by age and period of service and by State and age. September 30, 1991.Google Scholar
  4. 4.
    Unpublished data extracted from the VA Patient Treatment File, FY93-FY94. A breast cancer related admission is defined as any hospital admission with any of the following ICD-9-CM discharge diagnoses: ICD9CM: 174,217,233.0,238.3,239.3,610.1 or 611.72.Google Scholar
  5. 5.
    U. S. General Accounting Office (GAO). VA Health Care for Women (GAO/HRD=T2-93) January, 1992.Google Scholar
  6. 6.
    U.S. DVA. 1992 Report of the VA Advisory Committee on Women Veterans.Google Scholar
  7. 7.
    U.S. DVA, Women Veteran Newsletter, April, 1995.Google Scholar
  8. 8.
    Fletcher SW, Black, W, Harris R, Rimer, BK, Shapiro S. Report of the International Workshop on Screening for Breast Cancer. J Natl Cancer Inst 1993; 85:1644–56.PubMedCrossRefGoogle Scholar
  9. 9.
    Glick JK, Gelber RD, Goldhirsch A, et al. Adjuvant therapy of primary breast cancer. Ann Oncol 1992; 3(10): 801–9.PubMedGoogle Scholar
  10. 10.
    Feussner JR, and Hynes DM. Breast Cancer Among Women Veterans: Pilot Feasibility Study. Final Report to the Department of Veterans Affairs, Health Services Research and Development Service, 1995.Google Scholar
  11. 11.
    American College of Radiology, et al. Standards for Breast Conserving Treatment. Cancer J Clin 1992;42(3):134–62.CrossRefGoogle Scholar
  12. 12.
    Feather BL and Wainstock JM. Perceptions of Postmastectomy Patients. Part 1: The Relationship Between Social Support and Network Providers. Cancer Nursing 1989; 12(5):293–300.PubMedGoogle Scholar
  13. 13.
    Osteen RT, Cady B, Chmiel JS, Clive RE, Doggett RLS, Friedman MA, Hussey DK, Kraybill W, Urist, Winchester D. The 1991 National Survey of Carcinoma of the Breast by the Commission on Cancer. J Am Coll Surg. 1994; 178(3): 213–219.PubMedGoogle Scholar
  14. 14.
    Studnicki J, Schapira DV, Bradham DD, Clark RA, Jarrett A. Response to the National Cancer Institute Alert. The Effect of Practice Guidelines on Two Hospitals in the Same Medical Community. Cancer 1993; 72(10): 2986–92.PubMedCrossRefGoogle Scholar
  15. 15.
    Nattinger AB, Gottlieb MS, Hoffman RG, Walker AP, Goodwin J S. Minimal Increase in the Use of Breast Conserving Surgery from 1986 to 1990. Medical Care 1996; 34(5): 479–89.PubMedCrossRefGoogle Scholar
  16. 16.
    Hynes, DM. The quality of breast cancer care in local communities: Implications of health care reform. Medical Care 19; 32(4): 328–40.Google Scholar
  17. 17.
    Grilli R and Repetto, L Variation in use of breast conserving surgery in Lombardia, Italy Intl J Technol Assess Health Care 1995; 11(4): 733–40.CrossRefGoogle Scholar
  18. 18.
    Whelan T, Marcellus D, Clark, R, Levine M. Adjuvant radiotherapy for early breast cancer: Patterns of practice in Ontario. Can Med Assoc J 1993; 149(9): 1273–7.Google Scholar
  19. 19.
    Grilli R, Mainini F, Penna A, Bertolino B, Scopiglione N, Torri V, Liberati A. Inappropriate halsted mastectomy and patient volume in Italian hospitals. Am J Public Health 1993; 83(12): 1762–4.PubMedGoogle Scholar
  20. 20.
    Johnson TP, Wamecke RB, and Aitken MJ. Changing practice patterns In: Kaluzny, A.D. and Wamecke, R.B. (Eds) Managing a Health Care Alliance: Improving Community Cancer Care. Jossey-Bass: San Francisco, CA, 1996.Google Scholar
  21. 21.
    Hynes, DM. The Role of Patient, Provider and Health Insurance Characteristics in the Quality of Breast Cancer Care. Doctoral Dissertation. University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, 1991.Google Scholar
  22. 22.
    Hurley SF, Livingston PM, Jolley DJ, Hart SA. Patterns of surgical treatment of breast cancer in Victoria. Austral New Zealand J Surg. 1990; 60(11): 871–8.Google Scholar
  23. 23.
    Chu J, Diehr P, Fiegl P, Glaefke G, Begg C, Glicksman A, Ford L. The effect of age on the care of women with breast cancer in community hospitals. J Gerontol 1987; 42(2): 185–190.PubMedGoogle Scholar
  24. 24.
    Greenfield S, Blanco DM, Elashoff PM, and Ganz PA Patterns of care related to age of breast cancer patients. JAMA 1987; 257(20): 2766–70.PubMedCrossRefGoogle Scholar
  25. 25.
    McFall, SL, Wamecke, RB, Kaluzny, AD, Aitken, Nt Ford, L. Physician and practice characteristics associated with judgements about breast cancer treatment. Medical Care 1994; 32(2): 106–117.PubMedCrossRefGoogle Scholar
  26. 26.
    Kosecoff, J, Kanouse, DE, Brook, RH. Changing practice patterns in the management of breast cancer: consensus development program. Health Serv Res 1990; 25(5): 809–23.PubMedGoogle Scholar
  27. 27.
    Niccolucci, A, Mainini, Penna, A, et al. The influence of patient characteristics on the appropriateness of surgical treatment for breast cancer patients. Ann Oncol 1993; 4(2): 133–41.Google Scholar
  28. 28.
    Tanneberger, S, Pannetta, A, Pannuti, F. How does the message of cancer specialists affect routine medical practice? Only sixty percent of surgical adjuvant breast cancer treatment is based on hormone receptor status. Ann Oncol 1994; 5(8): 773–4.PubMedGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1998

Authors and Affiliations

  • Denise M. Hynes
    • 1
  • Edward HinesJr.
    • 1
  • Lori A. Bastian
    • 2
  1. 1.VA HospitalLoyola UniversityChicago
  2. 2.Durham VA Medical CenterDuke UniversityDurham

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