Relation between appropriateness of primary therapy for early-stage breast carcinoma and increased use of breast-conserving surgery
Relation between appropriateness of primary therapy for early-stage breast carcinoma and increased use of breast-conserving surgery
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DOI：
10.1016/s0140-6736(00)02757-4
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发表时间：
2000-09-30
期刊：
影响因子：
168.9
通讯作者：
Schapira, MM
中科院分区：
文献类型：
--
作者：
Nattinger, AB;Hoffmann, RG;Schapira, MM
背景保乳手术是一种比乳房切除术更复杂的治疗方法，因为需要单独的切口进行腋窝淋巴结清扫，术后放疗是必要的。我们推测，通过这种治疗到临床实践中可能会导致之间的差异的护理建议和received.Methods我们使用的记录，美国国家监测，流行病学和最终结果肿瘤登记研究144：759名妇女年龄在30岁及以上谁接受手术的早期乳腺癌在1983年和1995年之间。我们计算了至少接受最低适当初级治疗的比例（根据1990年美国国立卫生研究院共识会议的建议，在每3个月的时间内，接受适当的初级治疗的妇女比例从88%下降到88%，到1995年底，这一比例已从1983年的89%上升到78%。在年龄、种族、阶段和人口密度的所有亚组中均观察到这种下降。在队列中的所有女性中，接受不适当形式乳房切除术的比例在整个研究期间保持稳定，约为2.7%。接受不适当形式的保乳手术（省略放疗、腋窝淋巴结清扫或两者兼有）的比例从1989年的10%增加到1995年底的19%。解释虽然大多数妇女接受适当的护理，但美国早期乳腺癌的护理适当性从1990年到1995年下降。由于所有接受保乳手术的妇女比例增加，而且这种方法比乳房切除术更容易被不适当地应用，因此所有接受不适当护理的妇女比例增加。
Background Breast-conserving surgery is a more complex treatment than mastectomy, because a separate incision is needed for axillary lymph-node dissection, and postoperative radiotherapy is necessary. We postulated that adoption of this therapy into clinical practice might have led to discrepancies between the care recommended and that received.Methods We used records of the US national Surveillance, Epidemiology, and End Results tumour registry to study 144:759 women aged 30 years and older who underwent surgery for early-stage breast cancer between 1983 and 1995. We calculated the proportion undergoing at least the minimum appropriate primary treatment (defined, in accordance with the recommendations of a National Institutes of Health Consensus Conference in 1990, as total mastectomy with axillary node dissection or breast-conserving surgery wit axillary node dissection and radiotherapy) during each 3-month period.Findings The proportion of women receiving appropriate primary therapy fell from 88% in 1983-89 to 78% by the end of 1995. This decline was observed in all subgroups of age, race, stage, and population density. Of all women in the cohort, the proportion undergoing an inappropriate form of mastectomy remained stable at about 2.7% throughout the study period. The proportion undergoing an inappropriate form of breast-conserving surgery (omission of radiotherapy, axillary node dissection, or both) increased from 10% in 1989 to 19% at the end of 1995.Interpretation Although most women undergo appropriate care, the appropriateness of care for early-stage breast cancer in the USA declined from 1990 to 1995. Because the proportion of all women who were treated by breast-conserving surgery increased, and because this approach was more likely than was mastectomy to be applied inappropriately, the proportion of all women having inappropriate care increased.