Abstract
Over 27,000 patients with breast cancer were identified from cancer registry data from 1978 to 1992 and differences in treatment practice across the 16 districts of Yorkshire studied. A total of 50 surgeons treated more than an average of ten cases a year. Surgeons who expressed an interest in breast cancer were more likely to treat a greater number of patients than those who had no special interest in the disease and offered patients chemotherapy, hormone therapy and radiotherapy more often. The average regional mastectomy rate fell from 70% to 44% over this period, but the rate varied between districts from 13% to 87%, with those at the extremes occupying these positions year on year. The rate of uptake of radiotherapy varied between districts from 13% to 58% over the period 1978-92. The use of adjuvant chemotherapy increased from 5% to 19% and hormone therapy from 19% to 80% over this time period. An audit of the facilities available within each district carried out in early 1994 also showed considerable variation, although all districts now have access to a nurse specialist. There were wide variations in treatment offered to patients with breast cancer. Patients in some districts were denied access to chemo- and and radiotherapy despite published guidelines showing these modalities to be useful. It is recommended that patients are referred to units with an interest in breast cancer rather than to general surgical out-patients.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Farrow D. C., Hunt W. C., Samet J. M. Geographic variation in the treatment of localized breast cancer. N Engl J Med. 1992 Apr 23;326(17):1097–1101. doi: 10.1056/NEJM199204233261701. [DOI] [PubMed] [Google Scholar]
- Gazet J. C., Rainsbury R. M., Ford H. T., Powles T. J., Coombes R. C. Survey of treatment of primary breast cancer in Great Britain. Br Med J (Clin Res Ed) 1985 Jun 15;290(6484):1793–1795. doi: 10.1136/bmj.290.6484.1793. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hand R., Sener S., Imperato J., Chmiel J. S., Sylvester J. A., Fremgen A. Hospital variables associated with quality of care for breast cancer patients. JAMA. 1991 Dec 25;266(24):3429–3432. [PubMed] [Google Scholar]
- Holmes J. M., Sworn B. R. Lumbo-sacral Root Pain. Br Med J. 1946 Jun 22;1(4459):946–948. [PMC free article] [PubMed] [Google Scholar]
- Izuo M., Ishida T. Changing practices in the surgical treatment of breast cancer in Japan: a nationwide survey by the Japanese Breast Cancer Society. Surg Today. 1994;24(2):133–136. doi: 10.1007/BF02473394. [DOI] [PubMed] [Google Scholar]
- McCarthy M. Medical care of childhood leukaemia. Lancet. 1975 May 17;1(7916):1128–1130. doi: 10.1016/s0140-6736(75)92513-1. [DOI] [PubMed] [Google Scholar]
- Morris J. Regional variation in the surgical treatment of early breast cancer. Br J Surg. 1992 Dec;79(12):1312–1313. doi: 10.1002/bjs.1800791223. [DOI] [PubMed] [Google Scholar]
- Morris J., Royle G. T., Taylor I. Changes in the surgical management of early breast cancer in England. J R Soc Med. 1989 Jan;82(1):12–14. doi: 10.1177/014107688908200105. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Palmer C. R. Probability of recurrence of extreme data: an aid to decision-making. Lancet. 1993 Oct 2;342(8875):845–847. doi: 10.1016/0140-6736(93)92699-t. [DOI] [PubMed] [Google Scholar]
- Stiller C. A. Centralisation of treatment and survival rates for cancer. Arch Dis Child. 1988 Jan;63(1):23–30. doi: 10.1136/adc.63.1.23. [DOI] [PMC free article] [PubMed] [Google Scholar]