Lazovich D, White E, Thomas D B, Moe R E, Taplin S
Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, USA.
Arch Surg. 1997 Apr;132(4):418-23. doi: 10.1001/archsurg.1997.01430280092014.
To evaluate the use of breast-conserving surgery in western Washington before and after the National Institutes of Health Consensus Development Conference (June 18-21, 1990) during which breast-conserving surgery was recommended for most women with early invasive breast cancer.
Survey.
Population-based cancer registry in the Seattle-Puget Sound (Washington) region.
The survey included 13541 women in whom American Joint Committee on Cancer stage I or II breast cancer was diagnosed between January 1, 1983, and December 31, 1993.
Proportion of participants who underwent breast-conserving surgery.
From April 1985, after results of a US randomized controlled trial showing equivalent survival in women undergoing mastectomy or breast-conserving surgery were published, to the time of the Conference, breast-conserving surgery was performed on 44.8% of women with stage I and 25.8% with stage II breast cancer. These percentages increased to 54.9% and 35.2%, respectively, during the post-Conference period. While women with stage II breast cancer were less likely than women with stage I breast cancer to undergo breast-conserving surgery before and after the Conference, trends for age and education were attenuated after the Conference. Differences in the use of breast-conserving surgery observed before the Conference between countries of residence and among hospital types were also reduced after the Conference.
These findings suggest that the Conference recommendations had an effect on the adoption of breast-conserving surgery, particularly among groups who were previously least likely to undergo such surgery. Despite progress toward the Conference recommendation that the majority of women with early invasive breast cancer undergo breast-conserving surgery, the majority of women with stage II breast cancer undergo mastectomy.
评估美国国立卫生研究院共识发展会议（1990年6月18日至21日）前后华盛顿西部地区保乳手术的使用情况，该会议建议大多数早期浸润性乳腺癌女性采用保乳手术。
调查。
西雅图-普吉特海湾（华盛顿）地区基于人群的癌症登记处。
该调查纳入了1983年1月1日至1993年12月31日期间被诊断为美国癌症联合委员会I期或II期乳腺癌的13541名女性。
接受保乳手术的参与者比例。
从1985年4月，一项美国随机对照试验显示接受乳房切除术或保乳手术的女性生存率相当的结果发表后，到会议召开时，I期乳腺癌女性中有44.8%接受了保乳手术，II期乳腺癌女性中有25.8%接受了保乳手术。在会议后的时期，这些百分比分别增至54.9%和35.2%。虽然II期乳腺癌女性在会议前后比I期乳腺癌女性接受保乳手术的可能性小，但会议后年龄和教育程度的趋势有所减弱。会议前观察到的保乳手术使用情况在居住国家和医院类型之间的差异在会议后也有所减少。
这些发现表明会议建议对保乳手术的采用产生了影响，特别是在以前最不可能接受此类手术的群体中。尽管在朝着会议建议的大多数早期浸润性乳腺癌女性接受保乳手术的方向取得了进展，但大多数II期乳腺癌女性仍接受乳房切除术。
