Nattinger A B, Hoffman R G, Shapiro R, Gottlieb M S, Goodwin J S
Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
N Engl J Med. 1996 Oct 3;335(14):1035-40. doi: 10.1056/NEJM199610033351407.
We studied the effect of state legislation requiring the disclosure of options for the treatment of breast cancer on the use of breast-conserving surgery in clinical practice.
The National Cancer Institute's Surveillance, Epidemiology, and End Results registry provided data on women from 30 through 79 years of age who underwent breast-conserving surgery or mastectomy for local or regional breast cancer from 1983 through 1990. We examined the trend over time in use of breast-conserving surgery among patients in four sites (Connecticut, Iowa, Seattle, and Utah) where there were no state laws specifically requiring the disclosure of options for the treatment of breast cancer by physicians. For four additional sites (Detroit, Atlanta, New Mexico, and Hawaii) that had such legislation, we determined whether the rate of breast-conserving surgery after the legislation was different from the expected rate.
An attorney rated the legislation as giving most direction to physicians in Michigan, followed by Hawaii, Georgia, and New Mexico. The rate of breast-conserving surgery was up to 8.7 percent higher than expected in Detroit for six months after the passage of the Michigan law (P<0.01). The rate was up to 13.2 percent higher than expected in Hawaii for 12 months after that state's law was passed (P<0.05) and up to 6.0 percent higher than expected in Atlanta for 3 months after the passage of the Georgia law (P<0.01). After these transient increases, the surgery rates reverted to the expected levels. No significant effect was detected in New Mexico, where only a resolution without legal force was passed.
Legislation requiring physicians to disclose options for the treatment of breast cancer appeared to have only a slight and transient effect on the rate of use of breast-conserving surgery.
我们研究了要求披露乳腺癌治疗方案的州立法对临床实践中保乳手术使用情况的影响。
美国国立癌症研究所的监测、流行病学和最终结果登记处提供了1983年至1990年间30至79岁因局部或区域性乳腺癌接受保乳手术或乳房切除术的女性的数据。我们研究了四个未颁布专门要求医生披露乳腺癌治疗方案法律的地区（康涅狄格州、爱荷华州、西雅图和犹他州）患者使用保乳手术的时间趋势。对于另外四个颁布了此类法律的地区（底特律、亚特兰大、新墨西哥州和夏威夷），我们确定立法后保乳手术的发生率是否与预期发生率不同。
一名律师将这些法律评为对密歇根州医生指导最多的法律，其次是夏威夷州、佐治亚州和新墨西哥州。密歇根州法律通过后的六个月内，底特律的保乳手术率比预期高出8.7%（P<0.01）。夏威夷州法律通过后的12个月内，该州的保乳手术率比预期高出13.2%（P<0.05），佐治亚州法律通过后的三个月内，亚特兰大的保乳手术率比预期高出6.0%（P<0.01）。在这些短暂的上升之后，手术率恢复到预期水平。在仅通过了一项无法律效力决议的新墨西哥州，未检测到显著影响。
要求医生披露乳腺癌治疗方案的立法似乎对保乳手术的使用率仅产生了轻微和短暂的影响。
