Hill D J, White V M, Giles G G, Collins J P, Kitchen P R
Centre for Behavioural Research in Cancer, Anti-Cancer Council of Victoria, Carlton South.
Med J Aust. 1994 Jul 18;161(2):110-1, 114, 118 passim. doi: 10.5694/j.1326-5377.1994.tb127341.x.
To investigate the surgical practice and adjuvant therapies used in the treatment of primary operable breast cancer in Victoria in 1990 and compare them with results of a similar study in 1986.
All 856 cases of primary operable breast cancer registered by the Victorian Cancer Registry between 1 April and 30 September 1990 were identified. Each patient's surgeon was sent a standard questionnaire covering diagnosis, investigations, operative procedures, adjuvant therapies and reasons for certain management choices. Data were collected on 89% of the patients from 176 participating surgeons.
Most patients (82%) were referred to surgeons by general practitioners. Mammographic screening detected 14% of the cancers. The proportion of women receiving breast-conserving operations rose from 22% in 1986 to 42% in 1990. Surgeons operating on more than 20 breast cancers per annum were most likely to perform breast-conserving operations. The most common reasons given for non-conservative operations were the size of the tumour (37%), its central location (25%) and/or patient concern about the risk of recurrence if the breast was to be conserved (22%). Among these patients, reconstruction was done at the time of primary treatment in 13%, subsequently in 2%, and was planned by another 5%. Of all patients, 33% were referred to a radiation oncologist and 24% actually received radiotherapy (similar to 1986). Medical oncologists saw 33% of the patients and 20% of all patients received chemotherapy (similar to 1986), which was given by a medical oncologist in 83% of the cases. Use of endocrine therapy increased from 20% in 1986 to 40% in 1990.
There has been a strong trend towards more conservative breast surgery in Victoria, with surgeons who are most active in breast cancer surgery most likely to perform breast-conserving operations. Apart from a significant increase in the use of endocrine therapy, use of adjuvant therapies was unchanged from 1986.
调查1990年维多利亚州治疗原发性可手术乳腺癌所采用的外科手术方法及辅助治疗手段，并与1986年一项类似研究的结果进行比较。
确定了1990年4月1日至9月30日期间维多利亚癌症登记处登记的所有856例原发性可手术乳腺癌病例。向每位患者的外科医生发送了一份标准问卷，内容涵盖诊断、检查、手术程序、辅助治疗以及某些治疗选择的原因。从176名参与的外科医生那里收集了89%患者的数据。
大多数患者（82%）由全科医生转诊给外科医生。乳房X线筛查发现了14%的癌症。接受保乳手术的女性比例从1986年的22%上升到了1990年的42%。每年进行超过20例乳腺癌手术的外科医生最有可能进行保乳手术。非保乳手术最常见的原因是肿瘤大小（37%）、肿瘤位于中央（25%）和/或患者担心保乳后复发风险（22%）。在这些患者中，13%在初次治疗时进行了乳房重建，2%随后进行了重建，另有5%计划进行重建。所有患者中，33%被转诊给放射肿瘤学家，24%实际接受了放疗（与1986年相似）。肿瘤内科医生诊治了33%的患者，20%的所有患者接受了化疗（与1986年相似），其中83%的病例由肿瘤内科医生进行化疗。内分泌治疗的使用从1986年的20%增加到了1990年的40%。
在维多利亚州，乳腺癌手术有明显向更保守方向发展的趋势，在乳腺癌手术方面最活跃的外科医生最有可能进行保乳手术。除了内分泌治疗的使用显著增加外，辅助治疗的使用与1986年相比没有变化。
