This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

DeAnn Lazovich, PhD; Emily White, PhD; David B. Thomas, MD, DrPH; Roger E. Moe, MD; Stephen Taplin, MD, MPH

Arch Surg. 1997;132(4):418-423.

Abstract
Objective
To evaluate the use of breast-conserving surgery in western Washington before and after the National Institutes of Health Consensus Development Conference (June 18-21, 1990) during which breast-conserving surgery was recommended for most women with early invasive breast cancer.

Design
Survey.

Setting
Population-based cancer registry in the Seattle-Puget Sound (Washington) region.

Participants
The survey included 13 541 women in whom American Joint Committee on Cancer stage I or II breast cancer was diagnosed between January 1, 1983, and December 31, 1993.

Main Outcome Measure
Proportion of participants who underwent breast-conserving surgery.

Results
From April 1985, after results of a US randomized controlled trial showing equivalent survival in women undergoing mastectomy or breast-conserving surgery were published, to the time of the Conference, breast-conserving surgery was performed on 44.8% of women with stage I and 25.8% with stage 11 breast cancer. These percentages increased to 54.9% and 35.2%, respectively, during the post-Conference period. While women with stage II breast cancer were less likely than women with stage I breast cancer to undergo breast-conserving surgery before and after the Conference, trends for age and education were attenuated after the Conference. Differences in the use of breast-conserving surgery observed before the Conference between counties of residence and among hospital types were also reduced after the Conference.

Conclusions
These findings suggest that the Conference recommendations had an effect on the adoption of breast-conserving surgery, particularly among groups who were previously least likely to undergo such surgery. Despite progress toward the Conference recommendation that the majority of women with early invasive breast cancer undergo breast-conserving surgery, the majority of women with stage II breast cancer undergo mastectomy.

Arch Surg. 1997;132:418-423

Author Affiliations
From the Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis (Dr Lazovich); the Public Health Sciences Division, Fred Hutchinson Cancer Research Center (Drs White and Thomas); the Departments of Epidemiology (Drs White and Thomas), Surgery (Dr Moe), and Family Medicine (Dr Taplin), University of Washington, Seattle; and the Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle (Dr Taplin).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Economic Evaluation of Breast Cancer Treatment: Considering the Value of Patient Choice
Polsky et al.
JCO 2003;21:1139-1146.
ABSTRACT | FULL TEXT  

A first look at variations in use of breast conserving surgery at five teaching hospitals in Japan
ISHIZAKI et al.
Int J Qual Health Care 2002;14:411-418.
ABSTRACT | FULL TEXT  

Relationship Between Travel Distance and Utilization of Breast Cancer Treatment in Rural Northern Michigan
Meden et al.
JAMA 2002;287:111-111.
FULL TEXT  

Costs of Treatment for Elderly Women With Early-Stage Breast Cancer in Fee-for-Service Settings
Warren et al.
JCO 2002;20:307-316.
ABSTRACT | FULL TEXT  

Determining the Quality of Breast Cancer Care: Do Tumor Registries Measure Up?
Bickell and Chassin
ANN INTERN MED 2000;132:705-710.
ABSTRACT | FULL TEXT