Adelson P, Lim K, Churches T, Nguyen R
New South Wales Health Department, North Sydney, Australia.
Aust N Z J Surg. 1997 Jan;67(1):9-14. doi: 10.1111/j.1445-2197.1997.tb01886.x.
The purpose of this study was to examine existing data on women diagnosed with breast cancer in New South Wales in 1991 and 1992 and to describe surgical treatments received on an inpatient basis.
Analyses were based on the linkage of two databases: the New South Wales Central Cancer Registry and the New South Wales Health Department's Inpatient Statistics Collection. Data were limited to women who were resident and treated in New South Wales. Main analyses were restricted to definitive surgical procedures.
Thirty-six per cent of women treated surgically for breast cancer in 1991 had breast-conserving therapy. This had increased to 39% in 1992. There were substantial geographical variations in the use of breast-conserving therapy in New South Wales which could not be explained by patient characteristics. Age, degree of spread at diagnosis, and area health service/ health region were all found to have an independent association with the probability of having a mastectomy.
Women with a localized degree of spread living in non-metropolitan areas (Health Regions) were almost twice as likely to have a mastectomy as compared with similar women who were resident in metropolitan areas (Area Health Services). The concentration of radiotherapy services may have contributed to the urban/rural variation in breast-conserving therapy in New South Wales, but it is also likely that some of the variations that were observed may be a reflection of the failure of clinicians to use best current practice.
本研究旨在审视1991年和1992年在新南威尔士州被诊断为乳腺癌的女性的现有数据，并描述她们接受的住院手术治疗情况。
分析基于两个数据库的关联：新南威尔士州中央癌症登记处和新南威尔士州卫生部的住院统计数据收集库。数据仅限于在新南威尔士州居住并接受治疗的女性。主要分析限于确定性手术程序。
1991年接受乳腺癌手术治疗的女性中有36%接受了保乳治疗。这一比例在1992年增至39%。新南威尔士州在保乳治疗的使用上存在显著的地理差异，而这些差异无法用患者特征来解释。研究发现，年龄、诊断时的扩散程度以及地区卫生服务/健康区域均与接受乳房切除术的可能性存在独立关联。
与居住在大城市地区（地区卫生服务机构）的类似女性相比，居住在非大城市地区（健康区域）且扩散程度局限的女性接受乳房切除术的可能性几乎高出一倍。放疗服务的集中可能导致了新南威尔士州保乳治疗的城乡差异，但观察到的一些差异也可能反映出临床医生未采用当前最佳实践。
