Breast-conserving surgery for breast cancer: Patterns of care in a geographic region and estimation of potential applicability

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Abstract
Background: It has been postulated that one of the rewards of breast cancer screening is the increased likelihood of receiving breast-conserving surgery. The recent wide application of screening mammography has led to an acceleration in the otherwise gradual shift toward smaller, earlier-stage breast cancer that has been occurring since the turn of the century. Methods: We examined data from patients with pathologically diagnosed breast cancers from all general hospitals in the state of Vermont for use of breast-conserving surgery by era (1975–1984 [n=1,652] versus 1989–1990 [n=683]), method of cancer detection, age, clinical tumor-node-metastases (cTNM) stage, pathologic size, and node status. Results: Cancers detected by mammography were 2% in 1975–1984 and 36% in 1989–1990. Invasive breast cancers Conclusions: Most of the variation in breast-conserving surgery was related to factors other than patient age and stage of disease. Variation was probably related more to local community factors and physician attitudes. At least two-thirds of the women in the state were eligible for breast-conserving surgery even before the wide use of mammography screening.

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