Polissar L, Finley M L
Soc Sci Med. 1985;21(7):733-40. doi: 10.1016/0277-9536(85)90120-0.
The relationship between type of biopsy-mastectomy procedure and four sets of independent variables (physician, patient, hospital and tumor characteristics) was examined for 993 locally-staged breast cancer patients diagnosed between 1974 and 1981 in 13 counties of western Washington State. Time trends were also investigated. Cases were selected from records of a population-based cancer registry. The frequency of the two-step procedure, in which biopsy and surgery occur on different days, increased from 28 to 57% during the 8-year study period. Use of the two-step procedure was associated with younger age of the patient, less suspicious symptoms or mammogram results, younger physician cohorts and hospitals with government and health maintenance organization proprietorship. These relationships remained unchanged after controlling for potentially confounding variables. There were also substantial differences between individual hospitals in the frequency of the two-step procedure, suggesting differing schools of thought in different locales.
对1974年至1981年间在华盛顿州西部13个县诊断出的993例局部分期乳腺癌患者，研究了活检-乳房切除术的类型与四组独立变量（医生、患者、医院和肿瘤特征）之间的关系。还调查了时间趋势。病例选自基于人群的癌症登记记录。在为期8年的研究期间，活检和手术在不同日期进行的两步法手术频率从28%增加到了57%。采用两步法手术与患者年龄较轻、症状或乳房X光检查结果可疑性较低、医生群体较年轻以及政府和健康维护组织所有制的医院有关。在控制了潜在的混杂变量后，这些关系保持不变。各医院之间在两步法手术频率上也存在显著差异，这表明不同地区存在不同的观念。
