Mastectomy versus breast-conserving therapy in the treatment of stage I and II carcinoma of the breast: a randomized trial at the National Cancer Institute.

Lichter, Allen S.; Lippman, Marc E.; Danforth, David N.; D’Angelo, Teresa; Steinberg, Seth M.; Demoss, Ernest V.; MacDonald, H; Reichert, Cheryl M.; Merino, María J.; Swain, Sandra M.

doi:10.1200/jco.1992.10.6.976

Cited by 311 publications

(156 citation statements)

References 40 publications

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“…We can only speculate about the cause. The decrease manifested following publications showing an increased local recurrence risk after BCS for patients with larger tumours, tumours with an extensive in situ component and for patients younger than 40 years (Delouche et al, 1987;Bartelink et al, 1988;Boyages et al, 1990;Lichter et al, 1992). Also, in this period the breast-screening program rapidly expanded, which may have resulted in logistic problems in hospitals and radiotherapy facilities.…”

Section: As Reference)mentioning

confidence: 99%

Guideline adherence for early breast cancer before and after introduction of the sentinel node biopsy

et al. 2005

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This population-based study aimed to analyse variations in surgical treatment and guideline compliance with respect to the application of radiotherapy and axillary lymph node dissection (ALND), for early breast cancer, before and after the sentinel node biopsy (SNB) introduction. The study included 13 532 consecutive surgically treated stage I -IIIA breast cancer patients diagnosed in 1989 -2002. Hospitals showed large variation in breast-conserving surgery (BCS) rates, ranging between 27 and 72% for T1 and 14 and 42% for T2 tumours. In multivariate analysis marked inter-hospital and time-dependent variation in the BCS rate remained after correction for case-mix. The guideline adherence was markedly lower for elderly patients. In 25.2% of the patients aged X75 years either ALND or radiotherapy were omitted. The proportion of patients with no ALND after an SNB increased from 1.8% in 1999 to 37.8% in 2002. However, in 2002 also 12.2% of the patients with a positive SNB did not have an ALND. Guideline compliance for BCS, with respect to radiotherapy and ALND, fell since the SNB introduction, from 96.1% before 2000 to 91.4% in 2002 (Po0.001). Noncompliance may however reflect patient-tailored medicine, as for elderly patients with small, radically resected primary tumours. The considerable variation in BCS-rates is more consistent with variations in surgeon preferences than patient's choice.

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Section: As Reference)mentioning

confidence: 99%

Guideline adherence for early breast cancer before and after introduction of the sentinel node biopsy

et al. 2005

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“…The 1990 NIH consensus statement on treatment of early stage breast carcinoma recommended BCT [39] and confirmed the wisdom of the recommendation through emergent evidence [40][41][42]. However, a high proportion of women categorized as low income and/or less educated continue to receive mastectomy rather than BCT [5,28,31,[43][44][45][46][47][48].…”

Section: Mastectomy Versus Breast-conserving Therapy (Bct)mentioning

confidence: 99%

Breast cancer disparities and decision-making among U.S. women

Polacek

Ramos

Ferrer

2007

Patient Education and Counseling

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Objective: The impact of breast cancer is immense for all women, but the literature reveals an even greater impact on women of color and among socially and economically disadvantaged populations. Persistent differences in incidence and outcome are undoubtedly due to multiple factors, but one element in poor outcome may be treatment choice. Those treatments shown to be related to best outcomes are less likely to be chosen by certain groups of women. The effects of economic and cultural factors on breast cancer treatment choice have not been thoroughly explored; these factors must be understood if health care professionals are to intervene effectively to address disparities and improve breast cancer outcomes for all women. Methods: A review of the breast cancer literature was conducted in order to: (1) describe breast cancer disparities in the United States; (2) delineate factors that might contribute to those disparities; (3) assess possible mitigating factors for predominant causes; (4) begin to decide how health care interventions might allay the factors that contribute to disparities in breast cancer incidence and mortality. Results: Breast cancer incidence and outcome disparities in the United States are due to multiple interacting factors. These include information about treatment, different types of treatment, the emotional context of decision-making, and patient preference for level of involvement. Treatment decision-making is complex. Conclusion: Health literacy and level of decision-making involvement, both embedded in social and economic reality, are key components in breast cancer treatment decision-making and may contribute to breast cancer disparities in the United States. Current models of shared decision-making may not be generalizable to all breast cancer patients. Practice implications: Optimal breast cancer outcomes for all women depend on culturally and ethnically appropriate professional support. #

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“…Whereas a radical or modified radical mastectomy used to be the standard treatment, it is now clear that in appropriate cases breast-conserving treatment achieves equivalent long-term survival rates (Veronesi et al, 1981;Sarrazin et al, 1983;Fisher et al, 1985;Van Dongen et al, 1991;Lichter et al, 1992). Furthermore, in the past 10 years it has become increasingly apparent that systemic adjuvant therapy following surgery leads to a reduction in recurrence rates and mortality (Early Breast Cancer Trialists' Collaborative Group, 1992).…”

mentioning

confidence: 99%

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

Richards

Wolfe²,

Tilling³

et al. 1996

Br J Cancer

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Mastectomy versus breast-conserving therapy in the treatment of stage I and II carcinoma of the breast: a randomized trial at the National Cancer Institute.

Abstract: These data add further weight to the conclusion that breast conservation using lumpectomy and breast irradiation is equivalent to mastectomy in terms of survival and ultimate local control for stage I and II breast cancer patients.

Cited by 311 publications

References 40 publications

Guideline adherence for early breast cancer before and after introduction of the sentinel node biopsy

Guideline adherence for early breast cancer before and after introduction of the sentinel node biopsy

Breast cancer disparities and decision-making among U.S. women

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

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