Management of breast cancer in southeast England

Chouillet, Anne-Marie; Bell, Chaim M.; J, Hiscox

doi:10.1136/bmj.308.6922.168

Cited by 77 publications

(42 citation statements)

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“…This has been confirmed by another study noting that stage was available in only 50% of Thames registry cases. 8 By contrast, the completeness of information on whether or not surgery was performed, and the type of surgery, was good. The type of surgery is usually recorded routinely in all hospitals in the clinical records and is easily available to cancer registries.…”

Section: Discussionmentioning

confidence: 98%

“…Cancer registries are now collecting more detailed information on care and clinical aspects of cancer management. [7][8][9][10][11][12][13][14] As part of the Eurocare project, we have now collected and analyzed population-based information from selected European cancer registries on the procedures used to diagnose and treat breast cancer. A single protocol was employed to abstract the clinical information.…”

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confidence: 99%

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Differences in stage and therapy for breast cancer across Europe

Sant

2001

Int. J. Cancer

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We examined variations in stage, diagnostic workup and therapy for breast cancer across Europe. Seventeen cancer registries in six European countries contributed 4,480 cases diagnosed in 1990 -91. The clinical records of these cases were examined, and the distribution of stage, diagnostic examinations and therapy were analyzed. Stage was earliest in the French registries, followed by those of Italy and Eindhoven (Netherlands). The proportion of stage I cancers was highest in the French areas with screening in place. Estonia, the English registries and Granada (Spain) had the most advanced stage at diagnosis. Use of liver ultrasonography varied from 84% (Italian registries) to 18% (Granada). Bone scan use varied from 81% (Italian registries) to 15% (Mersey, UK). The highest proportions treated by breast-conserving surgery were in the French (57%) and English registries (63%); the lowest were in Estonia (6%) and Granada (11%). The highest proportions of Halsted mastectomies were in Italy (19%) and Granada (8%). In all countries except England, 90% of operations included axillary lymphadenectomy. Medical treatment only was given to 8% of (mostly advanced) cases overall. Estonia (21%) and the English registries (14%) had the highest proportions of patients given medication only. Chemotherapy was given to low proportions of nodepositive cases in the Italian (76%) and English (74%) areas; breast-conserving surgery for stage I tumors varied from 24% in Granada to 84% in England. These wide differences in breast cancer care across Europe in the early 1990s indicate a need for continual monitoring of past treatments to help ensure application of the most effective protocols. © 2001 Wiley-Liss, Inc. Key words: breast cancer; population registries; care; survival; EuropeThe Eurocare project, which involved 45 population-based cancer registries in 17 European countries, revealed large variations in survival for breast cancer across Europe. These variations were attributed mainly to differences in stage at diagnosis, but the data also suggested that differences in the quality of care played a role. 1,2 Studies of patterns of cancer care are usually carried out on hospital series of patients selected with respect to the general population of cancer sufferers. These studies almost always originate from specialist oncological centers and usually exclude patients treated in non-specialist structures (general hospitals) and those not treated in hospital. [3][4][5][6] To provide a reliable picture of how cancer patients are cared for in current medical practice, it is necessary to study all the cases occurring in the population, or representative samples thereof. Only population-based cancer registries collect data on all cancer cases, and analyses deriving from them can provide indications as to the overall effectiveness of health care. However, the information on disease stage at diagnosis and on treatment collected routinely by most cancer registries is limited and insufficient to illuminate in detail the reasons for difference...

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Section: Discussionmentioning

confidence: 98%

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confidence: 99%

Differences in stage and therapy for breast cancer across Europe

Sant

2001

Int. J. Cancer

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“…BCT rates also increased in the USA and UK in the late 1980s and early 1990s (Chouillet et al, 1994;Richards et al, 1996;Nattinger et al, 1996;Lazovich et al, 1997) mainly, as in NSW, in women with smaller cancers (Lazovich et al, 1997). In the USA, rates of stage I cancers, which doubled from 1983 to 1996, were already at a high level by 1990 (National Cancer Institute, 1999) while BCT rates rose steadily from 1990 to 1995 (Lazovich et al, 1997;Nattinger et al, 2000).…”

Section: Surgery For Breast Cancer In Nsw Women 671mentioning

confidence: 99%

Breast conservation, mastectomy and axillary surgery in New South Wales women in 1992 and 1995

Kricker¹,

Haskill²,

Armstrong

2001

Br J Cancer

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SummaryTo measure the increase in uptake of BCT in NSW and its determinants, we examined Cancer Registry records of 2020 women with breast cancer in 1992 and 2883 in 1995 linked to records of their surgical treatment in the NSW Inpatient Statistics' Collection. In parallel, we examined trends and determinants in axillary surgery for breast cancer. Breast conservation increased from 39% of breast cancer in 1992 to 45% in 1995, mainly in women with the smallest cancers. In 1995, mastectomy was still most common in women with larger cancers (OR for breast cancers 3+ cm relative to <1 cm = 5.6, 95% CI 2.9-10.7) and cancers that had spread beyond the breast (OR = 2.0, 95% CI 1.4-2.7 relative to localized to the breast). Urban women had fewer mastectomies than rural women. Axillary surgery, common in 1992 (78%) and 1995 (82%), fell steeply with increasing age and more often accompanied mastectomy (93% in 1995) than BCT (67% in 1995). In 1995 the odds for axillary surgery were some two-fold or more higher for all cancers 1 cm or more in diameter compared with those <1.0 cm and highest for 2.0-2.9 cm cancers (OR = 3.3 95% CI 1.7-6.7 relative to <1.0 cm). Regional spread of the cancer at diagnosis was not a strong predictor. In the absence of collection of treatment data by cancer registries, linkage of cancer registry records with hospital inpatient data is an effective alternative for monitoring breast cancer treatment trends.

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“…Observational studies (Chouillet et al, 1994;Sainsbury et al, 1995b) showed considerable variability in breast service delivery. Greater specialisation (Gillis and Hole, 1996) and higher caseloads (Sainsbury et al, 1995a) were both shown to be associated with survival benefits.…”

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confidence: 99%

Breast cancer teams: the impact of constitution, new cancer workload, and methods of operation on their effectiveness

Haward¹,

et al. 2003

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National guidance and clinical guidelines recommended multidisciplinary teams (MDTs) for cancer services in order to bring specialists in relevant disciplines together, ensure clinical decisions are fully informed, and to coordinate care effectively. However, the effectiveness of cancer teams was not previously evaluated systematically. A random sample of 72 breast cancer teams in England was studied (548 members in six core disciplines), stratified by region and caseload. Information about team constitution, processes, effectiveness, clinical performance, and members' mental well-being was gathered using appropriate instruments. Two input variables, team workload (P ¼ 0.009) and the proportion of breast care nurses (P ¼ 0.003), positively predicted overall clinical performance in multivariate analysis using a two-stage regression model. There were significant correlations between individual team inputs, team composition variables, and clinical performance. Some disciplines consistently perceived their team's effectiveness differently from the mean. Teams with shared leadership of their clinical decision-making were most effective. The mental well-being of team members appeared significantly better than in previous studies of cancer clinicians, the NHS, and the general population. This study established that team composition, working methods, and workloads are related to measures of effectiveness, including the quality of clinical care.

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Management of breast cancer in southeast England

Abstract: There was a lack of consensus on the management of breast cancer among clinicians in 1990. More patients should be included in clinical trials.

Cited by 77 publications

References 4 publications

Differences in stage and therapy for breast cancer across Europe

Differences in stage and therapy for breast cancer across Europe

Breast conservation, mastectomy and axillary surgery in New South Wales women in 1992 and 1995

Breast cancer teams: the impact of constitution, new cancer workload, and methods of operation on their effectiveness

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