ISSN:
1534-4681
Keywords:
Breast-conserving surgery
;
Breast cancer
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Abstract Background: It has been postulated that one of the rewards of breast cancer screening is the increased likelihood of receiving breast-conserving surgery. The recent wide application of screening mammography has led to an acceleration in the otherwise gradual shift toward smaller, earlier-stage breast cancer that has been occurring since the turn of the century. Methods: We examined data from patients with pathologically diagnosed breast cancers from all general hospitals in the state of Vermont for use of breast-conserving surgery by era (1975–1984 [n=1,652] versus 1989–1990 [n=683]), method of cancer detection, age, clinical tumor-node-metastases (cTNM) stage, pathologic size, and node status. Results: Cancers detected by mammography were 2% in 1975–1984 and 36% in 1989–1990. Invasive breast cancers 〈2 cm maximum pathologic diameter were 34% in 1975–1984 and 50% in 1989–1990 (p〈0.001). Statewide, the use of breast-conserving surgery for invasive cancer increased from 8.6% in 1975–1984 to 42.9% in 1989–1990 (p〈0.001). In 1989–1990 at the single university hospital, 73% of the patients were treated with breast-conserving surgery versus 22% at the community hospitals (range 0–39%, p〈0.001). Differential referral patterns related to stage and age did not appear to explain the variation, because the percentages of cTNM stage I and II patients at the university hospital were similar to those of the community hospitals. Using the university hospital as the standard, we estimated that at least 67% of all patients in the state were eligible for breast-conserving surgery in the years 1975–1984 and 73% in the years 1975–1984, a 6% increase. Conclusions: Most of the variation in breast-conserving surgery was related to factors other than patient age and stage of disease. Variation was probably related more to local community factors and physician attitudes. At least two-thirds of the women in the state were eligible for breast-conserving surgery even before the wide use of mammography screening.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/BF02307035
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