Surgeon recommendations and receipt of mastectomy for treatment of breast cancer.
Surgeon recommendations and receipt of mastectomy for treatment of breast cancer.
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DOI：
10.1001/jama.2009.1450
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发表时间：
2009-10-14
影响因子：
120.7
通讯作者：
Katz, Steven J.
中科院分区：
文献类型：
--
作者：
Morrow, Monica;Jagsi, Reshma;Alderman, Amy K.;Griggs, Jennifer J.;Hawley, Sarah T.;Hamilton, Ann S.;Graff, John J.;Katz, Steven J.
人们担心乳房切除术在美国被过度使用。评估患者报告的外科医生初始建议与接受初始乳房切除术时寻求第二意见时给出的建议之间的关系；并评估保乳手术（BCS）后乳房切除术的使用。对2005年6月至2007年2月期间诊断为导管内或I期和II期乳腺癌的20至79岁妇女进行的一项调查，并向美国国家癌症研究所的监测、流行病学和最终结果登记处报告了加州洛杉矶和密歇根州底特律的大都市地区。采用快速病例确定方法确定患者，并对拉丁裔和黑人进行过采样。在3133名患者中，2290名患者回复（73.1%）。96.5%的受访者完成了邮寄调查，3.5%完成了电话调查。最终样本包括1984名女性患者（502名拉丁裔，529名黑人，953名非西班牙裔白人或其他）。首次乳房切除术的比率和使用原因（外科医生推荐，患者驱动，医学禁忌症）以及尝试BCS后乳房切除术的比率。在1984例患者中，1468例（75.4%）接受BCS作为初始手术治疗，460例接受了初始乳房切除术，其中13.4%遵循外科医生的建议，8.8%基于患者的偏好。大约20%的患者（n=378）寻求第二意见；在最初的外科医生建议进行乳房切除术的患者中（33.4%）比建议进行BCS的患者（15.6%）或未接受一种手术建议的患者（21.2%）更常见（P <.001）。12.1% （n=43）的外科医生在第二意见中对治疗建议存在不一致，且不因患者的种族/民族、教育程度或地理位置而存在差异。在1459名尝试BCS的女性中，37.9%的患者需要额外的手术，包括358例再次切除（26.0%）和167例乳房切除术（11.9%）。乳房切除术在II期癌症患者中最常见（P < 0.001）。保乳手术由外科医生推荐，并在大多数评估的患者中尝试，外科医生推荐，患者决定和BCS失败都影响乳房切除术率。
There is concern that mastectomy is overused in the United States. To evaluate the association of patient-reported initial recommendations by surgeons and those given when a second opinion was sought with receipt of initial mastectomy; and to assess the use of mastectomy after attempted breast-conserving surgery (BCS). A survey of women aged 20 to 79 years with intraductal or stage I and II breast cancer diagnosed between June 2005 and February 2007 and reported to the National Cancer Institute’s Surveillance, Epidemiology, and End Results registries for the metropolitan areas of Los Angeles, California, and Detroit, Michigan. Patients were identified using rapid case ascertainment, and Latinas and blacks were oversampled. Of 3133 patients sent surveys, 2290 responded (73.1%). A mailed survey was completed by 96.5% of respondents and 3.5% completed a telephone survey. The final sample included 1984 female patients (502 Latinas, 529 blacks, and 953 non-Hispanic white or other). The rate of initial mastectomy and the perceived reason for its use (surgeon recommendation, patient driven, medical contraindication) and the rate of mastectomy after attempted BCS. Of the 1984 patients, 1468 had BCS as an initial surgical therapy (75.4%) and 460 had initial mastectomy, including 13.4% following surgeon recommendation and 8.8% based on patient preference. Approximately 20% of patients (n=378) sought a second opinion; this was more common for those patients advised by their initial surgeon to undergo mastectomy (33.4%) than for those advised to have BCS (15.6%) or for those not receiving a recommendation for one procedure over another (21.2%) (P <.001). Discordance in treatment recommendations between surgeons occurred in 12.1% (n=43) of second opinions and did not differ on the basis of patient race/ethnicity, education, or geographic site. Among the 1459 women for whom BCS was attempted, additional surgery was required in 37.9% of patients, including 358 with reexcision (26.0%) and 167 with mastectomy (11.9%). Mastectomy was most common in patients with stage II cancer (P <.001). Breast-conserving surgery was recommended by surgeons and attempted in the majority of patients evaluated, with surgeon recommendation, patient decision, and failure of BCS all contributing to the mastectomy rate.
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DOI：
10.1158/1055-9965.epi-09-0238
发表时间：
2009-07
期刊：
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
影响因子：
--
作者：
Hamilton AS;Hofer TP;Hawley ST;Morrell D;Leventhal M;Deapen D;Salem B;Katz SJ
通讯作者：
Katz SJ
影响因子：
45.3
作者：
Tuttle, Todd M.;Habermann, Elizabeth B.;Virnig, Beth A.
通讯作者：
Virnig, Beth A.
影响因子：
10.3
作者：
Hawley, Sarah T.;Griggs, Jennifer J.;Katz, Steven J.
通讯作者：
Katz, Steven J.
DOI：
10.1016/j.jamcollsurg.2009.04.010
发表时间：
2009-08
影响因子：
5.2
作者：
Bleicher, Richard J.;Ciocca, Robin M.;Egleston, Brian L.;Sesa, Linda;Evers, Kathryn;Sigurdson, Elin R.;Morrow, Monica
通讯作者：
Morrow, Monica
影响因子：
2.1
作者：
Lee, M. Catherine;Rogers, Kendra;Sabel, Michael S.
通讯作者：
Sabel, Michael S.