Geographic variation in breast cancer care in Switzerland
Geographic variation in breast cancer care in Switzerland
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DOI：
10.1016/j.canep.2010.01.008
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发表时间：
2010-04-01
影响因子：
2.6
通讯作者：
Thuerlimann, B.
中科院分区：
文献类型：
--
作者：
Ess, S.;Savidan, A.;Thuerlimann, B.
目的：瑞士报告了乳腺癌结局的地区差异。本研究的目的是探讨乳腺癌早期诊断和管理的地理差异。研究方法：我们使用的数据来自2003年1月1日至2005年12月31日期间被诊断为浸润性乳腺癌的4820名妇女的代表性样本，这些妇女是由7个瑞士人口癌症登记处确定的。我们回顾性收集了有关检测模式、肿瘤特征和治疗的详细信息。使用卡方检验和单因素和多因素logistic回归对不同地理区域的差异进行统计学显著性检验。结果：各地区在早期乳腺癌的早期发现和管理方面存在相当大的差异。特别是，早期发现的癌症比例从瓦莱州的43%到圣加仑-埃因霍温的27%不等。乳房切除率从日内瓦的24%到圣加仑-埃塞尔和格里森-格拉鲁斯的38%不等。在乳房切除率较低的地区观察到较高的重建率。前哨淋巴结手术在淋巴结阴性疾病患者中的使用率在日内瓦较高，在瑞士东部较低。内分泌治疗和化疗的依从性差异不太明显，但有统计学意义。结论：这一分析表明，在以高支出、普遍获得服务和高度分散为特点的卫生系统中，乳腺癌护理存在相当大的地理差异。需要进一步研究这种变化对短期和长期患者结局的原因和影响。(C)2010爱思唯尔有限公司版权所有。
Purpose: Regional disparities in breast cancer outcomes have been reported in Switzerland. The purpose of this study is to investigate geographic variation in early diagnosis and management of breast cancer. Methods: We used data from a representative sample of 4820 women diagnosed with invasive breast cancer between January 1, 2003 and December 31, 2005 identified by seven Swiss population based cancer registries. We collected retrospectively detailed information on mode of detection, tumor characteristics and treatments. Differences across geographic regions were tested for statistical significance using chi-square tests and uni- and multivariate logistic regression. Results: Considerable disparities in early detection and management of early breast cancer were found across regions. In particular, the proportion of early detected cancer varied from 43% in Valais to 27% in St. Gallen-Appenzell. Mastectomy rates varied from 24% in Geneva to 38% in St. Gallen-Appenzell and Grisons-Glarus. Higher reconstruction rates were observed in regions with lower rates of mastectomy. The use of sentinel node procedure in patients with nodal negative disease was high in Geneva and low in Eastern Switzerland. Differences in compliance with recommendations on the use of endocrine therapy and chemotherapy were less pronounced but statistically significant. Conclusions: This analysis shows considerable geographic variation in breast cancer care in a health system characterized by high expenditures, universal access to services and high decentralization. Further study into the causes and effects of this variation on short- and long term patient outcomes is needed. (C) 2010 Elsevier Ltd. All rights reserved.