Annals of Surgical Oncology

, Volume 2, Issue 3, pp 275–280

Breast-conserving surgery for breast cancer: Patterns of care in a geographic region and estimation of potential applicability

  • Roger S. FosterJr
  • Mary E. Farwell
  • Michael C. Costanza
Original Articles

DOI: 10.1007/BF02307035

Cite this article as:
Foster, R.S., Farwell, M.E. & Costanza, M.C. Annals of Surgical Oncology (1995) 2: 275. doi:10.1007/BF02307035

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.

Key Words

Breast-conserving surgery Breast cancer 

Copyright information

© The Society of Surgical Oncology, Inc 1995

Authors and Affiliations

  • Roger S. FosterJr
    • 1
  • Mary E. Farwell
    • 1
  • Michael C. Costanza
    • 2
  1. 1.From the Vermont Cancer Center and the Department of SurgeryUniversity of VermontBurlingtonUSA
  2. 2.the Department of Mathematics and StatisticsUniversity of VermontBurlingtonUSA
  3. 3.Crawford Long Hospital of Emory UniversityAtlantaUSA

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