de Koning H J, van Dongen J A, van der Maas P J
Department of Public Health, Erasmus Universiteit, Rotterdam, The Netherlands.
Br J Cancer. 1994 Dec;70(6):1165-70. doi: 10.1038/bjc.1994.466.
The treatment of breast cancer patients has changed rapidly in the past decade, but empirical data at local and national level are scarce. Predicting the consequences of screening for primary treatment is consequently difficult. The aim of this analysis of records on admissions to hospital of women with breast cancer and/or for breast surgery (1975-90) together with a survey of all Dutch radiotherapy departments (1986-88) is to show the change in breast-conserving therapy and other primary treatment before the start of breast cancer screening in The Netherlands. There was a modest increase in breast-conserving therapy after 1981, coinciding with the first publication on its trial, followed by a sharp increase between 1985 and 1990, after the second publication. At the end of that 5 year period, 36% of all women with newly diagnosed invasive breast cancer underwent this type of surgery. Breast-conserving surgery is always followed by radiotherapy, but there has been a clear reduction in post-operative radiation after mastectomy. The percentage of breast-conserving therapy is at present higher in The Netherlands than in the USA. Implementing the Dutch screening programme will result in a maximum increase in breast-conserving therapy at national level of 34%, which stabilises at +21%, or a 50% maximum increase at local level. The number of women treated by mastectomy will ultimately decrease by 9%. Given the rapidity of change towards the use of breast-conserving surgery, which is enhanced by screening, recent information will be needed in predicting capacity and assessing whether screen-detected women are treated adequately.
在过去十年中，乳腺癌患者的治疗方式变化迅速，但地方和国家层面的实证数据却很匮乏。因此，预测筛查对初级治疗的影响十分困难。对乳腺癌女性患者入院记录及乳腺手术记录（1975 - 1990年）进行分析，并对荷兰所有放疗科室进行调查（1986 - 1988年），目的是展现荷兰乳腺癌筛查开始前保乳治疗及其他初级治疗的变化情况。1981年后保乳治疗有适度增加，这与关于保乳治疗试验的首次发表时间相符，随后在第二次发表后，1985年至1990年间出现大幅增长。在这5年期末，所有新诊断为浸润性乳腺癌的女性中有36%接受了此类手术。保乳手术后总是接着进行放疗，但乳房切除术后的放疗明显减少。目前荷兰保乳治疗的比例高于美国。实施荷兰筛查计划将使全国保乳治疗最多增加34%，稳定在增加21%，或在地方层面最多增加50%。最终接受乳房切除术的女性数量将减少9%。鉴于向保乳手术转变的速度很快，且筛查进一步加速了这一转变，因此在预测治疗能力以及评估筛查发现的女性是否得到充分治疗时，需要最新信息。
