ABSTRACT
BACKGROUND: This study examines changes in the management of ductal carcinoma in situ between 1995 and 1999 in the Australian State of Victoria. This period was before the release of Australian treatment recommendations. METHODS: All new cases of ductal carcinoma in situ diagnosed between 1 April and 30 September in 1995 and 1999 were identified from the population cancer registry. Treating surgeons completed a questionnaire on the presentation and management of each case. In 1995, 64 out of 70 surgeons returned questionnaires for 137 cases (case response, 94%). In 1999, 68 surgeons treated 159 registered cases and 141 completed surveys were returned (case response, 89%). RESULTS: More cases underwent an image-guided biopsy in 1999 (54%) than in 1995 (34%). Breast-conserving surgery (BCS) was used to treat 69% of cases in 1999 and 63% in 1995. The use of axillary procedures (clearance or sampling) for women treated by mastectomy decreased from 61% in 1995 to 30% in 1999. More patients treated with BCS had margins simply described as "clear" in 1995 (49%) than in 1999 (21%). In 1995, only 7% of cases treated with BCS had radiotherapy, and this was 25% in 1999. CONCLUSION: In both 1999 and 1995, the majority of patients were treated by BCS, but only a minority received radiotherapy.
Subject(s)
Breast Neoplasms/therapy , Carcinoma, Intraductal, Noninfiltrating/therapy , Practice Patterns, Physicians' , Breast Neoplasms/pathology , Breast Neoplasms/radiotherapy , Breast Neoplasms/surgery , Carcinoma, Intraductal, Noninfiltrating/pathology , Carcinoma, Intraductal, Noninfiltrating/radiotherapy , Carcinoma, Intraductal, Noninfiltrating/surgery , Combined Modality Therapy , Female , Humans , Lymph Node Excision , Mastectomy, Segmental , Middle Aged , Multivariate Analysis , Practice Patterns, Physicians'/trends , VictoriaABSTRACT
BACKGROUND: Clinical practice guidelines for the management of breast carcinoma were introduced in Australia in October, 1995. This article describes the management of early-stage breast carcinoma both before and after the introduction of these guidelines. METHODS: All cases of early breast carcinoma that were diagnosed over the same 6-month period in 1995 and 1999 and registered with a state-based cancer registry were identified. Treating surgeons completed a survey assessing tumor characteristics and primary treatment. In 1995, 95% of 188 surgeons who were approached participated and 96% of the surveys were returned. In 1999, 92% of 159 surgeons who were approached participated and 91% of the surveys were returned. Analyses are based on 1066 cases from 1995 and 1001 cases from 1999. RESULTS: The pathologic disease stage of the patients was similar in both study years. The proportion of patients who underwent breast-conserving therapy (BCT) increased from 54% in 1995 to 69% in 1999. This increase was noted across most levels of disease characteristics but was not evident among those patients treated by the least active surgeons. The proportion of patients treated with BCT who received radiotherapy increased from 59% in 1995 to 80% in 1999. This trend was observed across most levels of tumor characteristics and surgeon caseload. The proportion of women with receptor-positive tumors who were treated with endocrine therapy increased, whereas the proportion of patients with receptor-negative tumors who received this therapy decreased from 39% in 1995 to 17% in 1999. CONCLUSIONS: The management of early breast carcinoma in the state of Victoria appeared to change between 1995 and 1999 in the direction expected if the national guidelines had been incorporated into the practice patterns of surgeons treating breast carcinoma patients.
Subject(s)
Breast Neoplasms/pathology , Breast Neoplasms/therapy , Carcinoma/pathology , Carcinoma/therapy , Guideline Adherence , Practice Guidelines as Topic , Adult , Aged , Australia , Biopsy, Needle , Breast Neoplasms/mortality , Carcinoma/mortality , Chemotherapy, Adjuvant , Chi-Square Distribution , Combined Modality Therapy/standards , Female , Health Care Surveys , Humans , Mastectomy/methods , Middle Aged , Multivariate Analysis , Neoplasm Staging , Probability , Radiotherapy, Adjuvant , Registries , Risk Assessment , Surveys and Questionnaires , Survival Analysis , Treatment OutcomeABSTRACT
BACKGROUND: In the present paper we describe the presentation and management of ductal carcinoma in situ (DCIS) of the breast in women in Australia in 1995. This representative, national data set provides a historical comparator for studies examining DCIS management that follow. METHODS: Surgeons identified by population-based cancer registries as having treated a new diagnosis of DCIS between 1 April and 30 September 1995 completed a questionnaire on the presentation and management of each case. RESULTS: Two hundred and five surgeons supplied treatment details on 418 DCIS tumours in 415 women. Half of all tumours were detected at Breast Screen clinics and a further 25% were detected at other mammography centres. Twenty-six percent of tumours were palpable at presentation, 33% were multifocal and 55% were high grade (including comedocarcinoma). Breast conserving therapy (BCT) rather than mastectomy was utilized in 260 (62%)of cases. Tumours that were of low grade, small in size and not multifocal were more likely to be treated by BCT. Surgeons seeing six or moreDCIS cases in the 6-month period were more likely to utilize BCT. Of the conservatively treated cases, 22% were referred for a radiation oncology consultation. The most common reasons for treating DCIS with mastectomy were that the tumour was too extensive or multifocal (63%), it extended to margins of the specimen (42%), or patient concerns about recurrence (34%). CONCLUSIONS: In 1995 the majority of DCIS was treated with breast conserving surgery alone. Surgeons treating more DCIS cases were more likely to perform conservative surgery than surgeons treating only one DCIS case in the study period.
