UNDERUTILIZATION OF BREAST-CONSERVING SURGERY AND RADIATION-THERAPY AMONG WOMEN WITH STAGE-I OR STAGE-II BREAST-CANCER
UNDERUTILIZATION OF BREAST-CONSERVING SURGERY AND RADIATION-THERAPY AMONG WOMEN WITH STAGE-I OR STAGE-II BREAST-CANCER
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DOI：
10.1001/jama.266.24.3433
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发表时间：
1991-12-25
影响因子：
120.7
通讯作者：
MOE, RE
中科院分区：
文献类型：
--
作者：
LAZOVICH, D;WHITE, E;MOE, RE
Objective. - 目的：研究I期或II期乳腺癌患者行保乳手术（BCS）和术后放疗的时间趋势和相关因素。- Survey.Setting. - 西雅图-普吉特湾（华盛顿）地区基于人群的癌症登记。- 该研究纳入了1983年至1989年诊断为I期或II期乳腺癌（美国癌症联合委员会分期标准）的8095名妇女。- 保乳手术联合或不联合放疗与乳房切除术的比较，以及BCS患者中放疗与不放疗的比较。- 1985年，当美国BCS随机临床试验的结果发表时，BCS的频率达到峰值（I期46.3%; II期30.1%），随后II期乳腺癌女性恢复到1985年之前的水平，I期乳腺癌的下降幅度更小。BCS的可能性随着年龄的增加（P < .001），II期疾病，以及居住在该地区主要城市中心以外而降低，并且随着人口普查区域的教育（P < .001）或中位数收入（P < .001）而增加。BCS后接受放射治疗的妇女比例随年龄的增长而下降（P <0.001），II期妇女的比例低于I期妇女，在没有放射治疗设施的县最低。- 尽管有科学证据表明BCS与放射治疗和乳房切除术的疗效相当，但BCS并没有按照美国国立卫生研究院的建议对大多数I期或II期乳腺癌女性进行，并且与其使用相关的因素与美国国立卫生研究院概述的选择标准不同。
Objective. - To identify time trends and factors associated with breast-conserving surgery (BCS) and delivery of postoperative radiation therapy among women with stage I or II breast cancer.Design. - Survey.Setting. - Population-based cancer registry in the Seattle-Puget Sound (Wash) region.Participants. - The study included 8095 women diagnosed with stage I or II breast cancer (American Joint Committee on Cancer staging criteria) from 1983 through 1989.Main Outcome Measures. - Breast-conserving surgery with or without radiation therapy vs mastectomy, and, among women with BCS, a comparison of radiation therapy vs no therapy.Results. - In 1985 when results from a US randomized clinical trial of BCS were published, the frequency of BCS peaked (46.3% of stage I; 30.1 % of stage II) followed by a return to levels before 1985 for women with stage II breast cancer and a more moderate decline for stage I breast cancer. The likelihood of BCS decreased with increasing age (P < .001), with stage II disease, and with residence outside the region's major urban center, and it increased with education (P < .001) or median income (P < .001) by census tract. The proportion of women who received radiation therapy after BCS decreased with age (P < .001), was lower for women with stage II than stage I disease, and was lowest in counties without radiation therapy facilities.Conclusions. - Despite scientific evidence of the equivalent efficacy of BCS with radiation therapy and mastectomy, BCS is not performed on the majority of women with stage I or II breast cancer as recommended by the National Institutes of Health, and factors are associated with its use that differ from selection criteria outlined by the National Institutes of Health.