Utilization of Breast-Conserving Surgery in Breast Cancer
Authors: Robert O. Dillman, Sherri Chico, Sandra Finestone, Monica Morrow
Journal: Journal of Clinical Oncology (2001)

Article Tools SPECIAL DEPARTMENTS Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.2001.19.23.4350 Journal of Clinical Oncology - published online before print September 21, 2016 PMID: 11731521 Utilization of Breast-Conserving Surgery in Breast Cancer Robert O. DillmanxRobert O. DillmanSearch for articles by this author , Sherri ChicoxSherri ChicoSearch for articles by this author , Sandra FinestonexSandra FinestoneSearch for articles by this author Monica MorrowxMonica MorrowSearch for articles by this author Show More Hoag Cancer Center, Newport Beach, CANorthwestern University Medical School, Chicago, IL https://doi.org/10.1200/JCO.2001.19.23.4350 First Page Full Text PDF Figures and Tables © 2001 by American Society of Clinical OncologyjcoJ Clin OncolJournal of Clinical OncologyJCO0732-183X1527-7755American Society of Clinical OncologyResponse01122001In Reply:We thank Drs Dillman and Finestone and Ms Chico for their letter regarding our article. We would agree that data collected 7 years ago may not accurately reflect the precise incidence of breast-conserving surgery today. Unfortunately, the collection of large national data sets is a time-consuming and cumbersome process. The three national data systems, the Surveillance Epidemiology and End Results Program, the National Cancer Data Base, and the National Program of Cancer Registries, all take a minimum of 2 to 3 years to report cases ascertained in a given year, and detailed analysis such as the one in our report may take considerably longer. The need for more timely national cancer data collection was recognized in the Institute of Medicine report “Enhancing Data Systems to Improve the Quality of Cancer Care,”1 but this is unlikely to happen until computerized medical records and a more efficient system of collection for office-based data are routinely available. Although individual experiences such as the one provided by the authors are useful, there is no guarantee that they reflect national patterns of care. A Surveillance Epidemiology and End Results report examining time trends in the use of breast-conserving surgery between 1983 and 1995 indicates a very slow increase in the use of breast-conserving surgery, consistent with the findings of our study, with no evidence of a change in the slope of this curve during the latter portion of the time interval studied.2In addition, by focusing solely on the percentages of patients undergoing breast-conserving surgery, Dillman et al miss the major point of our article, which has to do with the factors that are being used to select patients for mastectomy. Although other studies have previously identified patient age, geographic location, and payer status as factors influencing the use of breast conservation,3-5 our study is one of the first to provide detailed information about the impact of clinical stage and histologic features of the tumor on treatment selection in a large patient population. The adoption of breast-conserving therapy has been a slow process, in spite of a large body of scientific data supporting its efficacy. The identification of factors used to inappropriately select patients for mastectomy provides an opportunity for targeted educational messages to patients and physicians.1. Hewitt M, Simone JV: Enhancing Data Systems To Improve The Quality of Cancer Care. Washington, DC, National Academy Press, pp 8,2000,-122 Google Scholar2. Du X, Freeman DH Jr, Syblik DA: What drove changes in the use of breast conserving surgery since the early 1980’s? The role of clinical trial, celebrity action and an NIH consensus statement. Breast Cancer Res Treat 562:: 71,2000-79, Google Scholar3. Farrow DC, Hunt WC, Samet JW: Geographic variation in the treatment of localized breast cancer. N Engl J Med 36:: 1097,1992-1101, Google Scholar4. Nattinger AB, Hoffmann RG, Shairo R, et al: The effect of legislative requirements on the use of breast conserving surgery. N Engl J Med 335:: 1035,1996-1040, Crossref, Medline, Google Scholar5. Lazovich D, White E, Thomas DB, et al: Underutilization of breast-conserving surgery and radiation therapy among women with stage I and II breast cancer. JAMA 226:: 3422,1991-3438, Google Scholar