Nattinger A B, Gottlieb M S, Veum J, Yahnke D, Goodwin J S
Department of Medicine, Medical College of Wisconsin, Milwaukee 53226.
N Engl J Med. 1992 Apr 23;326(17):1102-7. doi: 10.1056/NEJM199204233261702.
In the past decade there has been an increase in the use of treatment designed to conserve the breast for women with breast cancer. The extent to which such treatment has been adopted in various regions of the country and whether characteristics of hospitals and patients predict its use is not known, however.
We used national data on Medicare claims for inpatient care provided in 1986 to study 36,982 women 65 to 79 years of age, who had local or regional breast cancer and underwent either mastectomy or breast-conserving treatment (local excision, quadrantectomy, or subtotal mastectomy). Information about the hospitals at which these women were treated was obtained from an American Hospital Association survey.
Of the 36,982 women, 12.1 percent had breast-conserving surgery and 87.9 percent had a mastectomy. The frequency of breast-conserving surgery ranged from 3.5 percent to 21.2 percent in various states. The highest rate of use was in the Middle Atlantic states (20.0 percent) and New England (17.2 percent), and the lowest was in the East South Central states (5.9 percent) and the West South Central states (7.3 percent). Breast-conserving treatment was used more often in urban than in rural areas, in teaching hospitals than in nonteaching hospitals, in large hospitals than in small hospitals, and in hospitals with on-site radiation therapy or geriatric services than in others. Most of the geographic variation persisted after adjustment for the characteristics of hospitals and patients for which data were available.
There is substantial geographic variation in the use of breast-conserving surgery, which cannot be explained by differences in hospital characteristics. Hospital characteristics that were independently redictive of greater use of breast-conserving surgery were the size of the metropolitan area, the status of the institution as a teaching hospital, and the availability of radiation therapy and geriatric services.
在过去十年中，针对乳腺癌女性的保乳治疗使用有所增加。然而，这种治疗在该国不同地区的采用程度以及医院和患者的特征是否能预测其使用情况尚不清楚。
我们使用1986年医疗保险住院护理索赔的全国数据，研究了36982名65至79岁患有局部或区域性乳腺癌且接受了乳房切除术或保乳治疗（局部切除、象限切除或次全乳房切除术）的女性。这些女性接受治疗的医院信息来自美国医院协会的一项调查。
在这36982名女性中，12.1%接受了保乳手术，87.9%接受了乳房切除术。保乳手术的频率在不同州从3.5%到21.2%不等。使用率最高的是中大西洋各州（20.0%）和新英格兰地区（17.2%），最低的是东中南部各州（5.9%）和西中南部各州（7.3%）。保乳治疗在城市地区比农村地区使用更频繁，在教学医院比非教学医院使用更频繁，在大型医院比小型医院使用更频繁，在有现场放射治疗或老年服务的医院比其他医院使用更频繁。在对可获得数据的医院和患者特征进行调整后，大部分地理差异仍然存在。
保乳手术的使用存在显著的地理差异，这不能用医院特征的差异来解释。独立预测保乳手术使用增加的医院特征是大都市地区的规模、机构作为教学医院的地位以及放射治疗和老年服务的可用性。
