Foster R S, Farwell M E, Costanza M C
Vermont Cancer Center, Burlington, USA.
Ann Surg Oncol. 1995 May;2(3):275-80. doi: 10.1007/BF02307035.
It has been postulated that one of the rewards of breast cancer screening is the increased likelihood of receiving breast-conserving surgery. The recent wide application of screening mammography has led to an acceleration in the otherwise gradual shift toward smaller, earlier-stage breast cancer that has been occurring since the turn of the century.
We examined data from patients with pathologically diagnosed breast cancers from all general hospitals in the state of Vermont for use of breast-conserving surgery by era (1975-1984 [n = 1,652] versus 1989-1990 [n = 683]), method of cancer detection, age, clinical tumor-node-metastases (cTNM) stage, pathologic size, and node status.
Cancers detected by mammography were 2% in 1975-1984 and 36% in 1989-1990. Invasive breast cancers < 2 cm maximum pathologic diameter were 34% in 1975-1984 and 50% in 1989-1990 (p < 0.001). Statewide, the use of breast-conserving surgery for invasive cancer increased from 8.6% in 1975-1984 to 42.9% in 1989-1990 (p < 0.001). In 1989-1990 at the single university hospital, 73% of the patients were treated with breast-conserving surgery versus 22% at the community hospitals (range 0-39%, p < 0.001). Differential referral patterns related to stage and age did not appear to explain the variation, because the percentages of cTNM stage I and II patients at the university hospital were similar to those of the community hospitals. Using the university hospital as the standard, we estimated that at least 67% of all patients in the state were eligible for breast-conserving surgery in the years 1975-1984 and 73% in the years 1975-1984, a 6% increase.
Most of the variation in breast-conserving surgery was related to factors other than patient age and stage of disease. Variation was probably related more to local community factors and physician attitudes. At least two-thirds of the women in the state were eligible for breast-conserving surgery even before the wide use of mammography screening.
据推测，乳腺癌筛查的益处之一是接受保乳手术的可能性增加。近年来，乳腺钼靶筛查的广泛应用加速了自世纪之交以来乳腺癌逐渐向更小、更早阶段发展的趋势。
我们研究了佛蒙特州所有综合医院经病理诊断为乳腺癌的患者数据，按年代（1975 - 1984年[n = 1652]与1989 - 1990年[n = 683]）、癌症检测方法、年龄、临床肿瘤-淋巴结-转移（cTNM）分期、病理大小和淋巴结状态分析保乳手术的使用情况。
通过乳腺钼靶检测出的癌症在1975 - 1984年为2%，在1989 - 1990年为36%。最大病理直径<2 cm的浸润性乳腺癌在1975 - 1984年为34%，在1989 - 1990年为50%（p<0.001）。在全州范围内，浸润性癌保乳手术的使用率从1975 - 1984年的8.6%增至1989 - 1990年的42.9%（p<0.001）。1989 - 1990年，在单一大学医院，73%的患者接受了保乳手术，而社区医院为22%（范围0 - 39%，p<0.001）。与分期和年龄相关的不同转诊模式似乎无法解释这种差异，因为大学医院cTNM I期和II期患者的比例与社区医院相似。以大学医院为标准，我们估计该州在1975 - 1984年至少67%的患者符合保乳手术条件，在1989 - 1990年为73%，增加了6%。
保乳手术的差异大多与患者年龄和疾病分期以外的因素有关。差异可能更多地与当地社区因素和医生态度有关。即使在乳腺钼靶筛查广泛应用之前，该州至少三分之二的女性符合保乳手术条件。
