title: Hospital-related differences in breast cancer management. Analysis of an unselected population-based series of 1353 radically operated patients.
abstract: A retrospective review is presented of 1353 consecutive patients with histopathologically confirmed invasive breast carcinoma treated radically with curative intent during the decade 1980-89. None had received adjuvant systemic therapy with hormones or prolonged chemotherapy. The distribution of lymph-node negative (N-) and lymph-node positive (N+) patients was 75% and 25%, respectively. The treatment and outcome were analysed as regards conventional prognostic parameters, in particular considering the axillary lymph-node status and the responsible hospital category (General Municipal Hospitals (MH)) versus Comprehensive Cancer Center (CC)). The most striking difference was detected as regards the number of examined lymph nodes. The median number of nodes described at the MH was 7, as compared to 14 at the CC (p < 0.001). In patients with pT1 tumours the highest rate of lymph-node positivity was observed when 10 or more axillary nodes were removed. Adjuvant radiotherapy reduced the loco-regional recurrence rate in the N-patients, whereas only the regional recurrences were reduced among the N+ patients. The five- and 10-year tumor-related survival rates were 86% and 76%, respectively, with no difference between the MH and the CC. As life-prolonging adjuvant hormone therapy and chemotherapy is now available for patients with axillary lymph node metastases, it is important that patients with breast cancer are operated adequately with the aim to remove at least 10 axillary lymph nodes. A thorough examination of the axillary content should be performed by the pathologist, and the number of resected lymph nodes and metastases should be reported. The establishment of nation-wide standard criteria for the management of breast cancer is recommended.
authors.affiliation: Department of Clinical Oncology and Radiotherapy, Ullevaal Hospital, Oslo, Norway.
authors.forename: N K
authors.initials: NK
authors.lastname: Raabe
authors.forename: R
authors.initials: R
authors.lastname: Kaaresen
authors.forename: S D
authors.initials: SD
authors.lastname: Fossaa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D002173:Cancer Care Facilities; D003131:Combined Modality Therapy; D005260:Female; D006769:Hospitals, General; D006773:Hospitals, Municipal; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008408:Mastectomy; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009664:Norway; D011379:Prognosis; D011878:Radiotherapy / Q000379:methods; D012008:Recurrence; D012044:Regression Analysis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome