Changes in the investigation and management of primary operable breast cancer in Victoria.
OBJECTIVE
To investigate the surgical practice and adjuvant therapies used in the treatment of primary operable breast cancer in Victoria in 1990 and compare them with results of a similar study in 1986.


METHODS
All 856 cases of primary operable breast cancer registered by the Victorian Cancer Registry between 1 April and 30 September 1990 were identified. Each patient's surgeon was sent a standard questionnaire covering diagnosis, investigations, operative procedures, adjuvant therapies and reasons for certain management choices. Data were collected on 89% of the patients from 176 participating surgeons.


RESULTS
Most patients (82%) were referred to surgeons by general practitioners. Mammographic screening detected 14% of the cancers. The proportion of women receiving breast-conserving operations rose from 22% in 1986 to 42% in 1990. Surgeons operating on more than 20 breast cancers per annum were most likely to perform breast-conserving operations. The most common reasons given for non-conservative operations were the size of the tumour (37%), its central location (25%) and/or patient concern about the risk of recurrence if the breast was to be conserved (22%). Among these patients, reconstruction was done at the time of primary treatment in 13%, subsequently in 2%, and was planned by another 5%. Of all patients, 33% were referred to a radiation oncologist and 24% actually received radiotherapy (similar to 1986). Medical oncologists saw 33% of the patients and 20% of all patients received chemotherapy (similar to 1986), which was given by a medical oncologist in 83% of the cases. Use of endocrine therapy increased from 20% in 1986 to 40% in 1990.


CONCLUSIONS
There has been a strong trend towards more conservative breast surgery in Victoria, with surgeons who are most active in breast cancer surgery most likely to perform breast-conserving operations. Apart from a significant increase in the use of endocrine therapy, use of adjuvant therapies was unchanged from 1986.
Centre for Behavioural Research in Cancer, Anti-Cancer Council of Victoria, Carlton South.
D J
DJ
Hill
V M
VM
White
G G
GG
Giles
J P
JP
Collins
P R
PR
Kitchen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D003404:Creatinine / Q000097:blood; D005260:Female; D013502:General Surgery; D006801:Humans; D008197:Lymph Node Excision / Q000706:statistics & numerical data; D016462:Mammaplasty / Q000706:statistics & numerical data; D008327:Mammography / Q000706:statistics & numerical data; D015411:Mastectomy, Modified Radical / Q000706:statistics & numerical data; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data; D008875:Middle Aged; D009367:Neoplasm Staging; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011365:Professional Practice Location; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012042:Registries; D012423:Rural Health / Q000706:statistics & numerical data; D014504:Urban Health / Q000706:statistics & numerical data; D014739:Victoria / Q000453:epidemiology
D003404:Creatinine