Farrow D C, Hunt W C, Samet J M
Department of Family and Community Medicine, University of New Mexico Medical Center, Albuquerque 87131-5306.
N Engl J Med. 1992 Apr 23;326(17):1097-101. doi: 10.1056/NEJM199204233261701.
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.
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.
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.
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.
20世纪80年代报道的临床试验表明，保乳手术加放射治疗在治疗局限性乳腺癌女性方面与改良根治性乳房切除术同样有效。美国各地区采用保乳手术的程度尚不清楚。
我们利用美国国立癌症研究所监测、流行病学和最终结果计划的数据，评估了1983年至1986年期间美国九个地区18399名非西班牙裔白人、324名西班牙裔和1174名黑人乳腺癌女性中保乳手术的使用差异。
1983 - 1984年，接受保乳手术的局限性乳腺癌白人女性比例从9.2%（爱荷华州）到32.1%（西雅图）不等，1985 - 1986年从19.6%（爱荷华州）到41.5%（西雅图）不等。1983年至1986年期间，每个地区保乳手术的使用都有所增加，但各地区的相对排名变化不大。黑人和西班牙裔女性使用保乳手术的频率与白人女性相当。保乳手术后接受放射治疗的女性比例在地理上也存在差异，并且在所有地区从1983年到1986年都有所增加。所有地区的老年女性以及亚特兰大和底特律的黑人女性在保乳手术后接受放疗的可能性低于其他女性。
在美国，局限性乳腺癌保乳手术的使用存在显著差异。尽管种族和年龄会影响保乳手术后放射治疗的使用，但这种差异无法用人口统计学因素来解释。
