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Change in the Use of Breast-Conserving Surgery in Western Washington After the 1990 NIH Consensus Development Conference

Change in the Use of Breast-Conserving Surgery in Western Washington After the 1990 NIH Consensus... Abstract Objective: To evaluate the use of breast-conserving surgery in western Washington before and after the National Institutes of Health Consensus Development Conference (June 18-21, 1990) during which breast-conserving surgery was recommended for most women with early invasive breast cancer. Design: Survey. Setting: Population-based cancer registry in the Seattle-Puget Sound (Washington) region. Participants: The survey included 13 541 women in whom American Joint Committee on Cancer stage I or II breast cancer was diagnosed between January 1, 1983, and December 31, 1993. Main Outcome Measure: Proportion of participants who underwent breast-conserving surgery. Results: From April 1985, after results of a US randomized controlled trial showing equivalent survival in women undergoing mastectomy or breast-conserving surgery were published, to the time of the Conference, breast-conserving surgery was performed on 44.8% of women with stage I and 25.8% with stage 11 breast cancer. These percentages increased to 54.9% and 35.2%, respectively, during the post-Conference period. While women with stage II breast cancer were less likely than women with stage I breast cancer to undergo breast-conserving surgery before and after the Conference, trends for age and education were attenuated after the Conference. Differences in the use of breast-conserving surgery observed before the Conference between counties of residence and among hospital types were also reduced after the Conference. Conclusions: These findings suggest that the Conference recommendations had an effect on the adoption of breast-conserving surgery, particularly among groups who were previously least likely to undergo such surgery. Despite progress toward the Conference recommendation that the majority of women with early invasive breast cancer undergo breast-conserving surgery, the majority of women with stage II breast cancer undergo mastectomy.Arch Surg. 1997;132:418-423 References 1. Veronesi U, Saccozzi R, Del Vecchio M, et al. Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast . N Engl J Med . 1981;305:6-11.Crossref 2. Sarrazin D, Le M, Rouesse J, et al. Conservative treatment versus mastectomy in breast cancer tumors with macroscopic diameter of 20 millimeters or less . Cancer . 1984;53:1209-1213.Crossref 3. Fisher B, Bauer M, Margolese R, et al. Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer . N Engl J Med . 1985:312:665-673.Crossref 4. Veronesi U, Banfi A, Del Vecchio M, et al. Comparison of Halsted mastectomy with quadrantectomy, axillary dissection and radiotherapy in early breast cancer: long term results . Eur J Cancer Clin Oncol . 1986:22:1085-1089.Crossref 5. Sarrazin D, Le MG, Arriagada R, et al. Ten-year results of a randomized trial comparing a conservative treatment to mastectomy in early breast cancer . Radiother Oncol . 1989;14:177-184.Crossref 6. Fisher B, Redmond C, Poisson R, et al. Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer . N Engl J Med . 1989:320:822-828.Crossref 7. NIH Consensus Conference. Treatment of early breast cancer . JAMA . 1991: 265:391-395.Crossref 8. Mann BA, Samet JM, Hunt WC, Key CR, Goodwin JM, Goodwin JS. Changing treatment of breast cancer in New Mexico from 1969 through 1985 . JAMA . 1988;259:3413-3417.Crossref 9. Swanson GM. Satariano ER, Satariano WA, Osuch JR. Trends in conserving treatment of invasive carcinoma of the breast in females . Surg Gynecol Obstet . 1990;171:465-471. 10. Lazovich D, White E, Thomas DB, Moe RE. Underutilization of breast-conserving surgery and radiation therapy among women with stage I or II breast cancer . JAMA . 1991;266:3433-3438.Crossref 11. Nattinger AB, Gottlieb MS, Veum J, Yahnke D, Goodwin JS. Geographic Variation in the use of breast-conserving treatment for breast cancer . N Engl J Med . 1992;326:1102-1107.Crossref 12. Osteen RT, Steele GD, Merck HR, Winchester DP. Regional differences in surgical management of breast cancer . CA Cancer J Clin . 1992;42:39-43.Crossref 13. Satariano ER, Swanson GM. Moll PP. Nonclinical factors associated with surgery received for treatment of early stage breast cancer . Am J Public Health . 1992;82:195-198.Crossref 14. Beahrs OH, Henson DE, Hutter RVP, Myers MH (American Joint Committee on Cancer), eds. Manual for Staging of Cancer . 3rd ed. Philadelphia, Pa: JB Lippincott Co; 1988:145-150. 15. Census of Population and Housing, 1990 [summary tape file 3A on CD-ROM]. Washington, DC: US Bureau of the Census; 1992. 16. American Society of Therapeutic Radiation Oncology. Membership Directory . Reston, Va: American Society of Therapeutic Radiation Oncology; 1990. 17. American Hospital Association American Hospital Association Guide to the Health Care Field . Chicago, III: American Hospital Association; 1989. 18. Council of Teaching Hospitals, Association of American Medical Colleges . Membership Directory . Washington, DC: Association of American Medical Colleges; 1988. 19. Breslow NE, Day NE. The analysis of case-control studies . In: Statistical Methods in Cancer Research . Lyon, France: International Agency for Research on Cancer; 1980;1. 20. Gleicher N. Cesarean section rates in the United States: the short-term failure of the NationalConsensus Development Conference in 1980 . JAMA . 1984; 252:3273-3276.Crossref 21. Kosecoff J, Kanouse DE, Brook RH. Changing practice patterns in the management of primary breast cancer: Consensus Development Program . Health Serv Res . 1990;25:809-823. 22. Kosecoff J, Kanouse DE, Rogers WH, McCloskey L, Winslow CM, Brook RH. Effects of the National Institutes of Health Consensus Development Program on physician practice . JAMA . 1987;258:2708-2713.Crossref 23. Sherman CR, Potosky AL, Weis KA, Ferguson JH. The Consensus Development Program: detecting changes in medical practice following a consensus conference on the treatment of prostate cancer . Int J Technol Assess Health Care . 1992;8:683-693.Crossref 24. Moxley JH, Allegra JC, Henney J, Muggia F. Treatment of primary breast cancer: summary of the National Institutes of Health Consensus Development Conference . JAMA . 1980;244:797-800.Crossref 25. Wilson RE, Donegan WL, Mettlin C, Smart CR, Murphy GP. The 1982 national survey of carcinoma of the breast in the United States by the American College of Surgeons . Surg Gynecol Obstet . 1984;159:309-318. 26. Mullan F, Jacoby I. The town metting for technology: the maturation of consensus conferences . JAMA . 1985;254:1068-1072.Crossref 27. Jacoby I, Clark SM. Direct mailing as a means of disseminating NIH consensus statements: a comparison with current techniques . JAMA . 1986;255:1328-1330.Crossref 28. Winkler JD, Kanouse DE, Brodsley L, Brook RH. Popular press coverage of eight National Institutes of Health consensus development topics . JAMA . 1986; 255:1323-1327.Crossref 29. Polissar L, Finley ML. Time trends and key factors in the choice of one-step or two-step biopsy and surgery for breast cancer . Soc Sci Med . 1985;21:733-740.Crossref 30. Rogers EM. Diffusion of Innovations . 3rd ed. New York, NY: Free Press; 1983. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Change in the Use of Breast-Conserving Surgery in Western Washington After the 1990 NIH Consensus Development Conference

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References (26)

Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1997.01430280092014
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To evaluate the use of breast-conserving surgery in western Washington before and after the National Institutes of Health Consensus Development Conference (June 18-21, 1990) during which breast-conserving surgery was recommended for most women with early invasive breast cancer. Design: Survey. Setting: Population-based cancer registry in the Seattle-Puget Sound (Washington) region. Participants: The survey included 13 541 women in whom American Joint Committee on Cancer stage I or II breast cancer was diagnosed between January 1, 1983, and December 31, 1993. Main Outcome Measure: Proportion of participants who underwent breast-conserving surgery. Results: From April 1985, after results of a US randomized controlled trial showing equivalent survival in women undergoing mastectomy or breast-conserving surgery were published, to the time of the Conference, breast-conserving surgery was performed on 44.8% of women with stage I and 25.8% with stage 11 breast cancer. These percentages increased to 54.9% and 35.2%, respectively, during the post-Conference period. While women with stage II breast cancer were less likely than women with stage I breast cancer to undergo breast-conserving surgery before and after the Conference, trends for age and education were attenuated after the Conference. Differences in the use of breast-conserving surgery observed before the Conference between counties of residence and among hospital types were also reduced after the Conference. Conclusions: These findings suggest that the Conference recommendations had an effect on the adoption of breast-conserving surgery, particularly among groups who were previously least likely to undergo such surgery. Despite progress toward the Conference recommendation that the majority of women with early invasive breast cancer undergo breast-conserving surgery, the majority of women with stage II breast cancer undergo mastectomy.Arch Surg. 1997;132:418-423 References 1. Veronesi U, Saccozzi R, Del Vecchio M, et al. Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast . N Engl J Med . 1981;305:6-11.Crossref 2. Sarrazin D, Le M, Rouesse J, et al. Conservative treatment versus mastectomy in breast cancer tumors with macroscopic diameter of 20 millimeters or less . Cancer . 1984;53:1209-1213.Crossref 3. Fisher B, Bauer M, Margolese R, et al. Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer . N Engl J Med . 1985:312:665-673.Crossref 4. Veronesi U, Banfi A, Del Vecchio M, et al. Comparison of Halsted mastectomy with quadrantectomy, axillary dissection and radiotherapy in early breast cancer: long term results . Eur J Cancer Clin Oncol . 1986:22:1085-1089.Crossref 5. Sarrazin D, Le MG, Arriagada R, et al. Ten-year results of a randomized trial comparing a conservative treatment to mastectomy in early breast cancer . Radiother Oncol . 1989;14:177-184.Crossref 6. Fisher B, Redmond C, Poisson R, et al. Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer . N Engl J Med . 1989:320:822-828.Crossref 7. NIH Consensus Conference. Treatment of early breast cancer . JAMA . 1991: 265:391-395.Crossref 8. Mann BA, Samet JM, Hunt WC, Key CR, Goodwin JM, Goodwin JS. Changing treatment of breast cancer in New Mexico from 1969 through 1985 . JAMA . 1988;259:3413-3417.Crossref 9. Swanson GM. Satariano ER, Satariano WA, Osuch JR. Trends in conserving treatment of invasive carcinoma of the breast in females . Surg Gynecol Obstet . 1990;171:465-471. 10. Lazovich D, White E, Thomas DB, Moe RE. Underutilization of breast-conserving surgery and radiation therapy among women with stage I or II breast cancer . JAMA . 1991;266:3433-3438.Crossref 11. Nattinger AB, Gottlieb MS, Veum J, Yahnke D, Goodwin JS. Geographic Variation in the use of breast-conserving treatment for breast cancer . N Engl J Med . 1992;326:1102-1107.Crossref 12. Osteen RT, Steele GD, Merck HR, Winchester DP. Regional differences in surgical management of breast cancer . CA Cancer J Clin . 1992;42:39-43.Crossref 13. Satariano ER, Swanson GM. Moll PP. Nonclinical factors associated with surgery received for treatment of early stage breast cancer . Am J Public Health . 1992;82:195-198.Crossref 14. Beahrs OH, Henson DE, Hutter RVP, Myers MH (American Joint Committee on Cancer), eds. Manual for Staging of Cancer . 3rd ed. Philadelphia, Pa: JB Lippincott Co; 1988:145-150. 15. Census of Population and Housing, 1990 [summary tape file 3A on CD-ROM]. Washington, DC: US Bureau of the Census; 1992. 16. American Society of Therapeutic Radiation Oncology. Membership Directory . Reston, Va: American Society of Therapeutic Radiation Oncology; 1990. 17. American Hospital Association American Hospital Association Guide to the Health Care Field . Chicago, III: American Hospital Association; 1989. 18. Council of Teaching Hospitals, Association of American Medical Colleges . Membership Directory . Washington, DC: Association of American Medical Colleges; 1988. 19. Breslow NE, Day NE. The analysis of case-control studies . In: Statistical Methods in Cancer Research . Lyon, France: International Agency for Research on Cancer; 1980;1. 20. Gleicher N. Cesarean section rates in the United States: the short-term failure of the NationalConsensus Development Conference in 1980 . JAMA . 1984; 252:3273-3276.Crossref 21. Kosecoff J, Kanouse DE, Brook RH. Changing practice patterns in the management of primary breast cancer: Consensus Development Program . Health Serv Res . 1990;25:809-823. 22. Kosecoff J, Kanouse DE, Rogers WH, McCloskey L, Winslow CM, Brook RH. Effects of the National Institutes of Health Consensus Development Program on physician practice . JAMA . 1987;258:2708-2713.Crossref 23. Sherman CR, Potosky AL, Weis KA, Ferguson JH. The Consensus Development Program: detecting changes in medical practice following a consensus conference on the treatment of prostate cancer . Int J Technol Assess Health Care . 1992;8:683-693.Crossref 24. Moxley JH, Allegra JC, Henney J, Muggia F. Treatment of primary breast cancer: summary of the National Institutes of Health Consensus Development Conference . JAMA . 1980;244:797-800.Crossref 25. Wilson RE, Donegan WL, Mettlin C, Smart CR, Murphy GP. The 1982 national survey of carcinoma of the breast in the United States by the American College of Surgeons . Surg Gynecol Obstet . 1984;159:309-318. 26. Mullan F, Jacoby I. The town metting for technology: the maturation of consensus conferences . JAMA . 1985;254:1068-1072.Crossref 27. Jacoby I, Clark SM. Direct mailing as a means of disseminating NIH consensus statements: a comparison with current techniques . JAMA . 1986;255:1328-1330.Crossref 28. Winkler JD, Kanouse DE, Brodsley L, Brook RH. Popular press coverage of eight National Institutes of Health consensus development topics . JAMA . 1986; 255:1323-1327.Crossref 29. Polissar L, Finley ML. Time trends and key factors in the choice of one-step or two-step biopsy and surgery for breast cancer . Soc Sci Med . 1985;21:733-740.Crossref 30. Rogers EM. Diffusion of Innovations . 3rd ed. New York, NY: Free Press; 1983.

Journal

Archives of SurgeryAmerican Medical Association

Published: Apr 1, 1997

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