Variations in the management and survival of women under 50 years with breast cancer in the South East Thames region

Richards, M. A.; Wolfe, Charles D.A.; Tilling, Kate; Barton, JeremyR; Bourne, H M; Gregory, WM

doi:10.1038/bjc.1996.131

Cited by 42 publications

(27 citation statements)

References 11 publications

(11 reference statements)

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“…Such differences have been observed between clinicians (Chouillet et al, 1994), between hospitals (Richards et al, 1996) and between health districts (Sainsbury et al, 1995a).…”

Section: Variations In Management and Survival Within The Ukmentioning

confidence: 87%

“…This broad approach has been supported by several reports from specialist professional bodies, such as the British Breast Group (Richards et al, 1994) and the British Association of Surgical Oncology (Anonymous, 1995), and has been endorsed by the House of Commons Select Committee on Health. The importance of specialist teams that manage an adequate volume of work has recently been stressed in guidance to purchasers from the Department of Health (NHS Executive, 1996).…”

Section: The Way Forwardmentioning

confidence: 97%

“…A recent study in the Southeast Thames Region (Richards et al, 1996) Executive, 1996). The conclusion drawn was that there is fairly strong evidence that centres/providers with higher case volume achieve better clinical long-term outcomes (5-year survival).…”

Section: Variations In Management and Survival Within The Ukmentioning

confidence: 99%

See 2 more Smart Citations

Inequalities in breast cancer care and outcome

Richards

Sainsbury²,

Kerr³

1997

Br J Cancer

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“…Such differences have been observed between clinicians (Chouillet et al, 1994), between hospitals (Richards et al, 1996) and between health districts (Sainsbury et al, 1995a).…”

Section: Variations In Management and Survival Within The Ukmentioning

confidence: 87%

Section: The Way Forwardmentioning

confidence: 97%

See 1 more Smart Citation

Inequalities in breast cancer care and outcome

Richards

Sainsbury²,

Kerr³

1997

Br 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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“…Hospital characteristics that have been reported to significantly affect treatment and outcomes include the teaching status [1][2][3][4][5][6][7][8][9][10][11] and location 1,8,[12][13][14][15] of the hospital, patient volume, 5,7,8,12,14,[16][17][18][19][20][21][22] and the onsite availability of specialized services needed for treatment. 1,7,10,20,23,24 In addition, more favourable outcomes have been demonstrated among women treated by physicians who have larger caseloads or more experience with patients with breast cancer.…”

mentioning

confidence: 99%

Early-stage breast cancer

Susman¹

2006

Oncology Times

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Background: The influence of organizational factors on the process and outcomes of the treatment of breast cancer has been extensively investigated. Although the quality of care is presumed to be better in larger centres, evidence is inconsistent. This study was conducted to determine whether therapies for patients with breast cancer varied according to hospital caseload. Methods: Women newly diagnosed between 1988 and 1994 with early-stage node-negative primary breast cancer were randomly selected from the Quebec tumour registry and the Quebec hospital discharge database. Data were collected from medical charts, and only women having undergone dissection of the axilla were included in the analyses. Logistic regression analysis was used to adjust for case mix and organizational variables. Results: The final sample included 1259 patients with node-negative stage I or II primary breast cancer. The proportion of women who underwent breast-conserving surgery increased significantly with hospital caseload (from 78.0% in hospitals admitting fewer than 25 new cases each year to 88.0% in those admitting 100 patients or more; p for trend < 0.001). This trend remained significant even after statistical adjustment for case mix and organizational factors (p for trend = 0.001). Of the 1039 women who underwent breast-conserving surgery 965 (92.9%) received radiotherapy. Use of systemic adjuvant therapy (tamoxifen or chemotherapy, or both) increased with the number of patients treated in a given centre (from 60.1% to 68.5%), but this trend disappeared after adjustment for case mix and other factors. The proportion of patients receiving systemic adjuvant therapy consistent with published consensus guidelines tended to increase with caseload for those treated in hospitals participating in multicentre clinical trials but decrease with caseload for patients in hospitals not involved in clinical research. Interpretation: The care of patients in Quebec with early-stage breast cancer is characterized by a high prevalence of both breast-conserving surgery and systemic adjuvant therapy. Large centres, especially those actively involved in clinical research, rapidly adopt innovative therapeutic modalities.

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Variations in the management and survival of women under 50 years with breast cancer in the South East Thames region

Abstract: Summary A retrospective, population-based study was

Cited by 42 publications

References 11 publications

Inequalities in breast cancer care and outcome

Inequalities in breast cancer care and outcome

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

Early-stage breast cancer

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