An analysis of factors determining the use of breast conserving surgery for treating early-stage breast cancer.

To determine the trend of breast conserving surgery (BCS) in West Virginia and to identify patient, hospital and surgeon factors associated with use of BCS, we conducted a study of all cases of Stage I and II invasive breast cancer treated surgically in West Virginia from 1991 through 1995 (N = 2411). These records were obtained from the State Cancer Registry. Multiple logistic regression was used to generate odds ratios (or) and 95% confidence intervals (CI) to determine factors associated with BCS. Our results showed the rate of BCS increased from 25% in 1991 to 37% in 1994 and 33% in 1995, with an overall rate of 33%. Multiple logistic regression identified the following factors associated with BCS: tumor size less than 1 cm (or = 1.47, 95% C1 = 1.4, 1.5), hospital bed size > 300 beds (or = 1.3, 95% C1 = 1.05-1.6) and a surgeon who had graduated from medical school since 1981 (or = 1.2, 95% C1 = 1.0, 1.36). We conclude the rate of BCS in West Virginia still remains low and that the women least likely to have BCS were women with tumors > 2 cm treated at small hospitals by older physicians.

Long-term trends in cancer mortality rates for West Virginia.

Using data on death certificates, we examined age-adjusted cancer mortality rates for West Virginia men and women from 1980-1994. The leading causes of cancer deaths among men in the state in 1994 were cancers of the lung, prostate, colon, and pancreas, and non-Hodgkin's lymphoma. Among West Virginia women in 1994, cancer deaths were most often due to cancers of the lung, breast, colon, pancreas, and ovary. Based on polynomial regression analyses, many of the leading cancer mortality rates significantly increased during 1980-1994. The most striking increase was a 76% rise in lung cancer mortality among West Virginia women. These mortality data underscore the continuing need for tobacco control and other cancer control practices. Even though barriers to medical care challenge the state's health care professionals, the burden of cancer in West Virginia can be reduced by prevention, early detection, and appropriate treatment.

The West Virginia Cancer Registry: historical development and preliminary results.

This article is designed to provide the medical community with an overview of the West Virginia Cancer Registry (WVCR), a population-based registry, which was established in 1993 with both federal and state funding. The WVCR is managed through the Bureau for Public Health's Division of Surveillance and Disease Control in the Office of Epidemiology and Health Promotion, and all data is confidential. The staff of the WVCR consists of a director, a cancer data supervisor, two abstractors, a secretary, and a voluntary, 13-member Cancer Advisory Committee. The initial findings of the WVCR have shown that for each 100,000 West Virginia women, 90.1 were discovered with invasive breast cancer in 1992, an increase from 86.8 in 1991. The invasive cervical cancer rate increased from 10.8 to 12.9 during this same time period. In addition, the age-adjusted death rate for cervical cancer rose from 3.6 cases per 100,000 women in 1991 to 3.8 in 1992. However, the age-adjusted death rate for breast cancer fell to 24.7 per 100,000 women in 1992, compared to 25.5 in 1991.