Variation in breast cancer surgery in Ontario.

OBJECTIVES

To analyse the extent of variation by county and hospital in the use of breast-conserving surgery in the initial management of breast cancer and to assess some factors that might explain the observed variation.

DESIGN

Population-based retrospective cohort study.

SETTING

Ontario.

PATIENTS

All women with breast cancer newly diagnosed from Jan. 1, 1989, to Dec. 31, 1991.

MAIN OUTCOME MEASURE

Proportion of women undergoing unilateral breast cancer surgery who had breast-conserving surgery in each hospital and county.

RESULTS

Of the 14,570 women with newly diagnosed breast cancer 12,815 (88.0%) underwent unilateral breast cancer surgery. The mean proportion of breast-conserving procedures by county was 52% and ranged from 11% to 84%. The proportion of breast-conserving procedures in individual hospitals with one or more cases of breast cancer per month ranged from 6% to 84%. The variations in the rates between hospitals was greater than that expected by chance alone (p < 0.0001).

CONCLUSIONS

There was marked variation at the hospital and county level in the use of breast-conserving surgery in the initial management of breast cancer. This variation was strongly associated with the hospital where the surgery was performed.