Breast-conserving surgery for breast cancer: patterns of care in a geographic region and estimation of potential applicability

Ann Surg Oncol. 1995 May;2(3):275-80. doi: 10.1007/BF02307035.


Background: It has been postulated that one of the rewards of breast cancer screening is the increased likelihood of receiving breast-conserving surgery. The recent wide application of screening mammography has led to an acceleration in the otherwise gradual shift toward smaller, earlier-stage breast cancer that has been occurring since the turn of the century.

Methods: We examined data from patients with pathologically diagnosed breast cancers from all general hospitals in the state of Vermont for use of breast-conserving surgery by era (1975-1984 [n = 1,652] versus 1989-1990 [n = 683]), method of cancer detection, age, clinical tumor-node-metastases (cTNM) stage, pathologic size, and node status.

Results: Cancers detected by mammography were 2% in 1975-1984 and 36% in 1989-1990. Invasive breast cancers < 2 cm maximum pathologic diameter were 34% in 1975-1984 and 50% in 1989-1990 (p < 0.001). Statewide, the use of breast-conserving surgery for invasive cancer increased from 8.6% in 1975-1984 to 42.9% in 1989-1990 (p < 0.001). In 1989-1990 at the single university hospital, 73% of the patients were treated with breast-conserving surgery versus 22% at the community hospitals (range 0-39%, p < 0.001). Differential referral patterns related to stage and age did not appear to explain the variation, because the percentages of cTNM stage I and II patients at the university hospital were similar to those of the community hospitals. Using the university hospital as the standard, we estimated that at least 67% of all patients in the state were eligible for breast-conserving surgery in the years 1975-1984 and 73% in the years 1975-1984, a 6% increase.

Conclusions: Most of the variation in breast-conserving surgery was related to factors other than patient age and stage of disease. Variation was probably related more to local community factors and physician attitudes. At least two-thirds of the women in the state were eligible for breast-conserving surgery even before the wide use of mammography screening.

Publication types

  • Multicenter Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Breast Neoplasms / surgery*
  • Chi-Square Distribution
  • Female
  • Hospitals, Community
  • Hospitals, University
  • Humans
  • Lymph Node Excision
  • Mammography / statistics & numerical data*
  • Mastectomy, Segmental / statistics & numerical data*
  • Medical Records
  • Middle Aged
  • Neoplasm Invasiveness
  • Neoplasm Staging
  • Registries
  • Retrospective Studies
  • Vermont / epidemiology