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.
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.
Authors: J A van Dongen; H Bartelink; I S Fentiman; T Lerut; F Mignolet; G Olthuis; E van der Schueren; R Sylvester; J Winter; K van Zijl Journal: J Natl Cancer Inst Monogr Date: 1992
Authors: U Veronesi; A Banfi; B Salvadori; A Luini; R Saccozzi; R Zucali; E Marubini; M Del Vecchio; P Boracchi; S Marchini Journal: Eur J Cancer Date: 1990 Impact factor: 9.162
Authors: B Fisher; C Redmond; R Poisson; R Margolese; N Wolmark; L Wickerham; E Fisher; M Deutsch; R Caplan; Y Pilch Journal: N Engl J Med Date: 1989-03-30 Impact factor: 91.245
Authors: U Veronesi; R Saccozzi; M Del Vecchio; A Banfi; C Clemente; M De Lena; G Gallus; M Greco; A Luini; E Marubini; G Muscolino; F Rilke; B Salvadori; A Zecchini; R Zucali Journal: N Engl J Med Date: 1981-07-02 Impact factor: 91.245
Authors: D Sarrazin; M G Lê; R Arriagada; G Contesso; F Fontaine; M Spielmann; F Rochard; T Le Chevalier; J Lacour Journal: Radiother Oncol Date: 1989-03 Impact factor: 6.280
Authors: Pamela M Vacek; Patricia Winstead-Fry; Roger H Secker-Walker; Gloria J Hooper; Dennis A Plante Journal: Qual Life Res Date: 2003-08 Impact factor: 4.147