Harries S A, Lawrence R N, Scrivener R, Fieldman N R, Kissin M W
Department of Surgery, University College London Medical School.
Ann R Coll Surg Engl. 1996 May;78(3 ( Pt 1)):197-202.
The management of breast cancer is controversial. In order to obtain an overview of the way that surgeons manage breast cancer in England and Wales and to assess trends in management by comparisons with the results of previous surveys a postal questionnaire was sent to all consultant general surgeons in England and Wales (n = 985). The response rate was 61%. Fine-needle aspiration is now the preferred technique to obtain a tissue diagnosis by 85% of surgeons. The majority of surgeons now treat early breast cancer either by breast-conserving surgery or offer the patient the choice of conservation or mastectomy. Comparisons with previous surveys carried out in the last 10 years suggest that fewer surgeons now recommend mastectomy. In all, 83% of surgeons indicated that they would biopsy the ipsilateral axilla routinely. Opinion is divided with regard to treatment of breast cancer in the elderly and treatment of an incompletely excised tumour, although the majority perform a mastectomy for a local recurrence after conservative surgery. Follow-up was regarded as worthwhile by 90%, but the majority do not routinely do follow-up investigations on asymptomatic patients apart from mammography. This study has shown very little consensus regarding the management of breast cancer in England and Wales. We suggest that the management of breast cancer should be in the hands of those with a special interest in the subject, as these surgeons will be more aware of ongoing clinical trials and current literature, more patients will then be entered into clinical trials and further trials instigated.
乳腺癌的治疗存在争议。为了全面了解英格兰和威尔士的外科医生治疗乳腺癌的方式，并通过与以往调查结果进行比较来评估治疗趋势，我们向英格兰和威尔士的所有普通外科顾问医生（共985人）发送了一份邮政调查问卷。回复率为61%。现在，85%的外科医生首选细针穿刺抽吸术来获取组织诊断。现在，大多数外科医生治疗早期乳腺癌时要么采用保乳手术，要么为患者提供保乳或乳房切除术的选择。与过去10年进行的以往调查相比，现在推荐乳房切除术的外科医生更少了。总体而言，83%的外科医生表示他们会常规对同侧腋窝进行活检。对于老年乳腺癌的治疗以及不完全切除肿瘤的治疗，意见存在分歧，不过大多数人会对保乳手术后的局部复发进行乳房切除术。90%的人认为随访是有价值的，但除了乳房X光检查外，大多数人不会对无症状患者进行常规随访调查。这项研究表明，在英格兰和威尔士，对于乳腺癌的治疗几乎没有达成共识。我们建议，乳腺癌的治疗应由对该主题有特殊兴趣的人来进行，因为这些外科医生会更了解正在进行的临床试验和当前的文献，这样会有更多患者进入临床试验，并推动进一步的试验开展。
