The rate of breast‐conserving surgery in early breast cancer: An audit of surgical practice at St Vincent’s campus, NSW in 1990 and 1994

Abstract

An audit was undertaken to document the use of breast-conserving surgery (BCS) in the management of early breast cancer (EBC) at St Vincent's campus during two time periods, the calendar years 1990 and 1994. The medical records of all women diagnosed with a new primary breast cancer at St Vincent's Public and Private Hospitals initially treated during 1990 and 1994 were reviewed to document patient, tumour and treatment characteristics. Comparisons were made with data on BCS in EBC from the Australian medical literature. A total of 228 patients was managed with a definitive surgical procedure in the years 1990 and 1994. There were no major differences in the manner of presentation, the tumour subtypes or the treatment techniques between the two years. There was an apparent increase in the number of tumours < 2 cm managed in 1994 but no major difference in the use of BCS. The BCS rates for the two years were 33 and 36%, respectively. There were wide variations in the rate of BCS between surgeons, and for the same surgeon, between the two calendar years. These data from a major teaching hospital serving a largely non-mammographically screened population would suggest that BCS rates for EBC are lower than expected. The data on BCS rates for EBC in Australia are limited and the optimal rate of BCS in current practice is unknown.

Absence of adverse early quality of life outcomes of radiation therapy in breast conservation therapy for early breast cancer

“…At the time of initial surgical decision‐making for early breast cancer, a woman is not only confronted by the diagnosis of malignancy but also has to interpret information regarding choice between breast conservation and mastectomy 12 . The rate of mastectomy has been shown to vary not only between regions but also have significant surgeon dependence 4,5 . Presumably this is related to the ways that the options between breast conservation and mastectomy are discussed with the patient.…”

“…In 1990 the US National Institute of Health Breast Cancer Consensus Conference declared that breast conservation therapy (BCT, the use of breast preserving surgery and radiation therapy) was the optimal local therapy for the majority of women with early breast cancer 1 . Despite this recommendation and the subsequent meta‐analyses of clinical studies, which have confirmed the equivalent local control and survival of BCT compared to mastectomy 2,3 , the audits of BCT suggest the technique remains underutilized in the community 4–6 .…”

“…Many factors have been described for this poor acceptance including patient age, regional location and surgeon preference 4–6 . Similarly avoidance of radiation therapy (RT) due to uncertainty about the negative impact 5,7 and imposition of RT may be associated with higher mastectomy rates.…”

Trends in Surgical Treatment of Younger Patients With Breast Cancer in Australia and New Zealand

“…In a Canadian study, the rate of BCS increased between 1981 and the early 1990s 19 . One New South Wales study showed that the BCS rates were 33 and 36% for 1990 and 1994, respectively, in a large public hospital 20 . There was a marginal increase in BCS use in Victoria from 63% in 1995 to 69% in 1999 21 .…”