Department of Surgery, McMaster University, Canada.
Breast. 2012 Dec;21(6):730-4. doi: 10.1016/j.breast.2012.07.017. Epub 2012 Aug 16.
We surveyed Canadian General Surgeons to examine decision-making in early stage breast cancer.
A modified Dillman Method was used for this mail survey of 1443 surgeons. Practice patterns and factors that influence management choices for: preoperative assessment, definition of margin status, surgical techniques and recommendations for re-excision were assessed.
The response rate was 51% with 41% treating breast cancer. Most (80%) were community surgeons, with equal distribution of low/medium/high volume and years of practice categories. Approximately 25% of surgeons "sometimes or frequently" performed diagnostic excisional biopsies while 90% report "frequently" or "always" performing preoperative core biopsies. There was marked variation in defining negative and close margins, in the use of intra-operative margin assessment techniques and recommendations for re-excision.
Responses revealed significant variation in attitudes and practices. These findings likely reflect an absence of consensus in the literature and potential gaps between best evidence and practice.
我们调查了加拿大普通外科医生，以研究早期乳腺癌的决策制定情况。
对 1443 名外科医生进行了这项邮件调查，采用了改良的 Dillman 法。评估了术前评估、切缘状态定义、手术技术以及再次切除建议等管理选择的实践模式和影响因素。
回复率为 51%，其中 41%的医生治疗乳腺癌。大多数（80%）是社区外科医生，低/中/高工作量和实践年限的分布相当。约 25%的外科医生“有时或经常”进行诊断性切除活检，而 90%的医生报告“经常”或“总是”进行术前核心活检。在定义阴性和切缘接近的标准、术中切缘评估技术的使用以及再次切除的建议方面存在明显差异。
研究结果表明，医生的态度和实践存在显著差异。这些发现可能反映了文献中缺乏共识以及最佳证据与实践之间存在潜在差距。
