Basnett I, Gill M, Tobias J S
Department of Public Health Medicine, Bloomsbury and Islington Health Authority, London, U.K.
Eur J Cancer. 1992;28A(12):1945-50. doi: 10.1016/0959-8049(92)90233-r.
We compared the management and outcome of 999 women with breast cancer presenting between 1982 and 1986 at two centres in a region, one in a teaching district. A comparison was also made with relevant research and The Kings Fund Consensus Statement. The centres frequently differed markedly in the investigations done, diagnostic procedures, histology reporting, axillary sampling, and in the treatment given, also differing from the Consensus with no trend towards it. Survival was better at the teaching centre, both disease-free (N.S.) and overall [odds ratio 1.46 (1.16-1.84) P = 0.0009 unadjusted]. This should be interpreted cautiously as the median follow-up time was relatively short and the study was non-randomised. We conclude that how women with breast cancer are managed is determined as much by where they are referred as by scientific evidence. This indicates the need to introduce standards and protocols into business plans, making audit and service specifications easier.
我们比较了1982年至1986年间在该地区两个中心就诊的999名乳腺癌女性的治疗情况和治疗结果，其中一个中心位于教学区。同时也与相关研究及国王基金共识声明进行了比较。两个中心在检查项目、诊断程序、组织学报告、腋窝取样以及所给予的治疗方面常常存在显著差异，并且与共识也不一致，没有趋向于共识的趋势。教学中心的生存率更高，无论是无病生存率（无统计学意义）还是总生存率[未调整的优势比为1.46（1.16 - 1.84），P = 0.0009]。由于中位随访时间相对较短且该研究并非随机研究，因此对此结果应谨慎解读。我们得出结论，乳腺癌女性的治疗方式很大程度上取决于她们被转诊至何处，而非科学证据。这表明有必要将标准和方案引入业务计划，以便更易于进行审核和制定服务规范。
