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• W1978041595 abstract "Starting in the early 1980s, randomised trials reported equivalent survival in patients with early-stage breast cancer receiving breast-conserving surgery and radiotherapy or modified radical mastectomy. 1 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 PubMed Scopus (1500) Google Scholar , 2 Morris AD Morris RD Wilson JF et al. Breast-conserving therapy vs mastectomy in early-stage breast cancer: a meta-analysis of 10-year survival. Cancer J Sci Am. 1997; 3: 6-12 PubMed Google Scholar , 3 NIH Consensus ConferenceTreatment of early stage breast cancer. JAMA. 1991; 265: 391-395 Crossref PubMed Scopus (1015) Google Scholar Treatment guidelines endorsed breast-conserving surgery and radiotherapy because of superior cosmetic results, within an informed decision-making framework. 3 NIH Consensus ConferenceTreatment of early stage breast cancer. JAMA. 1991; 265: 391-395 Crossref PubMed Scopus (1015) Google Scholar Subsequently, geographic variation in treatment rates has been widely reported, 4 Hebert-Croteau N Brisson J Pineault R Review of organizational factors related to care offered to women with breast cancer. Epidemiol Rev. 2000; 22: 228-238 Crossref PubMed Scopus (20) Google Scholar , 5 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 PubMed Scopus (502) Google Scholar , 6 Farrow DC Hunt WC Samet JM Geographic variation in the treatment of localized breast cancer. N Engl J Med. 1992; 326: 1097-1101 Crossref PubMed Scopus (453) Google Scholar , 7 Hewitt M Simone JV Ensuring quality cancer care. National Academy Press and Institute of Medicine National Research Council, Washington DC1999 Google Scholar typically in the context of concerns about the quality of breast cancer care. 7 Hewitt M Simone JV Ensuring quality cancer care. National Academy Press and Institute of Medicine National Research Council, Washington DC1999 Google Scholar Recently, L Caldon and colleagues 8 Caldon LJM Walters SJ Reed JA Murphy A Worley A Reed MWR Case-mix fails to explain variation in mastectomy rates: management of screen-detected breast cancer in a UK region 1997–2003. Br J Cancer. 2005; 92: 55-59 Crossref PubMed Scopus (29) Google Scholar reported on mastectomy rates in over 5000 women with breast cancer detected through the Trent Breast Screening Programme in 1987–2003. The proportion receiving mastectomy ranged from 25% to 45% across 11 breast screening units. After adjustment for case-mix (tumour size, site, grade, patients' age, and year of presentation), mastectomy rates still varied by screening unit. As noted by the authors, many factors in addition to the limited clinical characteristics that were explored, such as educational level, family income, and decision-making style, are likely to be associated with variation in surgery for early-stage breast cancer." @default.
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• W1978041595 title "Variations in surgery for early-stage breast cancer: what are we measuring?" @default.
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