BACKGROUND. Breast-conserving surgery followed by radiation therapy is as effective as modified radical mastectomy in treating women with localized breast cancer, as demonstrated by clinical trials reported during the 1980s. The extent to which breast-conserving surgery has been adopted in various regions of the United States is not known. METHODS. We assessed variations in the use of breast-conserving surgery from 1983 to 1986 in 18,399 non-Hispanic white, 324 Hispanic, and 1174 black women with breast cancer in nine areas of the United States, using data from the Surveillance, Epidemiology, and End-Results Program of the National Cancer Institute. RESULTS. The proportion of white women with localized breast cancer who underwent breast-conserving surgery ranged from 9.2 percent (Iowa) to 32.1 percent (Seattle) in 1983-1984 and from 19.6 percent (Iowa) to 41.5 percent (Seattle) in 1985-1986. Between 1983 and 1986, the use of breast-conserving surgery increased in each area, but the relative rankings of the areas changed little. The frequency of the use of breast-conserving surgery in black and Hispanic women was comparable to that in white women. The proportion of women who received radiation therapy after breast-conserving surgery also varied geographically and increased from 1983 to 1986 in all areas. Older women in all areas and black women in Atlanta and Detroit were less likely than other women to receive radiotherapy after breast-conserving surgery. CONCLUSIONS. There is marked variation in the United States in the use of breast-conserving surgery for localized breast cancer. The variation is not explained by demographic factors, although race and age affect the use of radiotherapy after breast-conserving surgery.
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Department of Family and Community Medicine, University of New Mexico Medical Center, Albuquerque 87131-5306.
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Chaudhry, R., Goel, V., Sawka, C.
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Mayberry, R. M., Mili, F., Ofili, E.
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[Abstract][Full Text]
Bickell, N. A., Chassin, M. R.
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132: 705-710
[Abstract][Full Text]
Earle, C. C., Venditti, L. N., Neumann, P. J., Gelber, R. D., Weinstein, M. C., Potosky, A. L., Weeks, J. C.
(2000). Who Gets Chemotherapy for Metastatic Lung Cancer?. Chest
117: 1239-1246
[Abstract][Full Text]
Mille, D., Roy, T., Carrere, M.-O., Ray, I., Ferdjaoui, N., Spath, H.-M., Chauvin, F., Philip, T.
(2000). Economic Impact of Harmonizing Medical Practices: Compliance With Clinical Practice Guidelines in the Follow-Up of Breast Cancer in a French Comprehensive Cancer Center. JCO
18: 1718-1724
[Abstract][Full Text]
Pennello, G., Devesa, S., Gail, M.
(2000). Association of Surface Ultraviolet B Radiation Levels with Melanoma and Nonmelanoma Skin Cancer in United States Blacks. Cancer Epidemiol. Biomarkers Prev.
9: 291-297
[Abstract][Full Text]
Athas, W. F., Adams-Cameron, M., Hunt, W. C., Amir-Fazli, A., Key, C. R.
(2000). Travel Distance to Radiation Therapy and Receipt of Radiotherapy Following Breast-Conserving Surgery. JNCI J Natl Cancer Inst
92: 269-271
[Full Text]
Whelan, T., Levine, M., Gafni, A., Sanders, K., Willan, A., Mirsky, D., Schnider, D., McCready, D., Reid, S., Kobylecky, A., Reed, K.
(1999). Mastectomy or Lumpectomy? Helping Women Make Informed Choices. JCO
17: 1727-1727
[Abstract][Full Text]
Riley, G. F., Potosky, A. L., Klabunde, C. N., Warren, J. L., Ballard-Barbash, R.
(1999). Stage at Diagnosis and Treatment Patterns Among Older Women With Breast Cancer: An HMO and Fee-for-Service Comparison. JAMA
281: 720-726
[Abstract][Full Text]
Hortobagyi, G. N.
(1998). Treatment of Breast Cancer. NEJM
339: 974-984
[Full Text]
Ray-Coquard, I., Philip, T., Lehmann, M., Fervers, B., Farsi, F., Chauvin, F.
(1997). Impact of a Clinical Guidelines Program for Breast and Colon Cancer in a French Cancer Center. JAMA
278: 1591-1595
[Abstract]
Deleyiannis, F. W.-B., Weymuller, E. A. Jr, Garcia, I., Potosky, A. L.
(1997). Geographic Variation in the Utilization of Esophagoscopy and Bronchoscopy in Head and Neck Cancer. Arch Otolaryngol Head Neck Surg
123: 1203-1210
[Abstract]
Nattinger, A. B., Hoffmann, R. G., Shapiro, R., Gottlieb, M. S., Goodwin, J. S.
(1996). The Effect of Legislative Requirements on the Use of Breast-Conserving Surgery. NEJM
335: 1035-1041
[Abstract][Full Text]
Newschaffer, C. J., Penberthy, L., Desch, C. E., Retchin, S. M., Whittemore, M.
(1996). The Effect of Age and Comorbidity in the Treatment of Elderly Women With Nonmetastatic Breast Cancer. Arch Intern Med
156: 85-90
[Abstract]
Potosky, A. L., Miller, B. A., Albertsen, P. C., Kramer, B. S.
(1995). The Role of Increasing Detection in the Rising Incidence of Prostate Cancer. JAMA
273: 548-552
[Abstract]
Berwick, D. M.
(1994). Eleven Worthy Aims for Clinical Leadership of Health System Reform. JAMA
272: 797-802
[Abstract]
Perez-Stable, E. J., Otero-Sabogal, R., Sabogal, F., McPhee, S. J., Hiatt, R. A.
(1994). Self-reported Use of Cancer Screening Tests Among Latinos and Anglos in a Prepaid Health Plan. Arch Intern Med
154: 1073-1081
[Abstract]
Lee-Feldstein, A., Anton-Culver, H., Feldstein, P. J.
(1994). Treatment Differences and Other Prognostic Factors Related to Breast Cancer Survival: Delivery Systems and Medical Outcomes. JAMA
271: 1163-1168
[Abstract]
Solin, L. J., Legorreta, A., Schultz, D. J., Zatz, S., Goodman, R. L.
(1994). The Importance of Mammographic Screening Relative to the Treatment of Women With Carcinoma of the Breast. Arch Intern Med
154: 745-752
[Abstract]
(1992). MORE EVIDENCE OF GEOGRAPHIC VARIATION IN BREAST-CANCER TREATMENT. JWatch General
1992: 2-2
[Full Text]
