Sainsbury R, Rider L, Smith A, MacAdam A
Royal Infirmary, Huddersfield, UK.
Br J Cancer. 1995 Jun;71(6):1275-8. doi: 10.1038/bjc.1995.246.
Over 27,000 patients with breast cancer were identified from cancer registry data from 1978 to 1992 and differences in treatment practice across the 16 districts of Yorkshire studied. A total of 50 surgeons treated more than an average of ten cases a year. Surgeons who expressed an interest in breast cancer were more likely to treat a greater number of patients than those who had no special interest in the disease and offered patients chemotherapy, hormone therapy and radiotherapy more often. The average regional mastectomy rate fell from 70% to 44% over this period, but the rate varied between districts from 13% to 87%, with those at the extremes occupying these positions year on year. The rate of uptake of radiotherapy varied between districts from 13% to 58% over the period 1978-92. The use of adjuvant chemotherapy increased from 5% to 19% and hormone therapy from 19% to 80% over this time period. An audit of the facilities available within each district carried out in early 1994 also showed considerable variation, although all districts now have access to a nurse specialist. There were wide variations in treatment offered to patients with breast cancer. Patients in some districts were denied access to chemo- and and radiotherapy despite published guidelines showing these modalities to be useful. It is recommended that patients are referred to units with an interest in breast cancer rather than to general surgical out-patients.
从1978年至1992年的癌症登记数据中识别出超过27000名乳腺癌患者，并对约克郡16个地区的治疗实践差异进行了研究。共有50名外科医生每年治疗的病例平均超过10例。对乳腺癌表现出兴趣的外科医生比那些对该疾病没有特殊兴趣的医生更有可能治疗更多的患者，并且更频繁地为患者提供化疗、激素治疗和放疗。在此期间，区域乳房切除术的平均比率从70%降至44%，但各地区的比率在13%至87%之间变化，处于极端水平的地区逐年保持这些位置。1978 - 1992年期间，各地区放疗的采用率在13%至58%之间变化。在此期间，辅助化疗的使用从5%增加到19%，激素治疗从19%增加到80%。1994年初对每个地区可用设施进行的一次审计也显示出相当大的差异，尽管现在所有地区都能接触到专科护士。为乳腺癌患者提供的治疗存在很大差异。尽管已发表的指南表明化疗和放疗有用，但一些地区的患者仍无法获得这些治疗。建议将患者转诊至对乳腺癌感兴趣的科室，而不是普通外科门诊。
