title: Changing attitudes towards breast-conserving treatment of early breast cancer in the south-eastern Netherlands: results of a survey among surgeons and a registry-based analysis of patterns of care.
abstract: To see whether personal preferences of surgeons can explain the trends in the use of breast-conserving therapy (BCT) of early breast cancer, questionnaires were sent to the surgeons of seven community hospitals in the south-eastern Netherlands in 1987 and 1995. The answers were set against the actual use of breast-conserving therapy in the hospitals in the period 1984-94, as monitored by the Eindhoven Cancer Registry. The proportion of surgeons who were willing to use BCT for tumours < or =3 cm increased from 43% in 1987 to 93% in 1995. In 1995, the majority of the surgeons considered multicentric tumour growth, diffuse microcalcifications on the mammogram and an extensive intraductal component around the tumour as contraindications for breast-conserving therapy. The proportion of patients with an operable, non-metastasized breast tumour of < or =5 cm in diameter undergoing breast-conservative surgery increased from 31% in 1984 to 60% in 1989 (P<0.01) and remained at that level in 1990 and 1991. Between 1991 and 1993, the proportion receiving breast-conservative surgery decreased significantly for patients younger than 50 years and a tumour 2.1-3.0cm in diameter, and also for those 50-69 years old with a tumour < or =2.0cm or 3.1-5.0cm across. The observed decrease in BCT in the south-eastern Netherlands in some subgroups seems to reflect the growing awareness of potential risk factors for local recurrence following BCT.
authors.affiliation: Comprehensive Cancer Centre South, Eindhoven, the Netherlands.
authors.forename: A C
authors.initials: AC
authors.lastname: Voogd
authors.forename: O J
authors.initials: OJ
authors.lastname: Repelaer van Driel
authors.forename: R M
authors.initials: RM
authors.lastname: Roumen
authors.forename: M A
authors.initials: MA
authors.lastname: Crommelin
authors.forename: M W
authors.initials: MW
authors.lastname: van Beek
authors.forename: J W
authors.initials: JW
authors.lastname: Coebergh
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001291:Attitude of Health Personnel; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D000075202:Contraindications; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D013502:General Surgery; D006764:Hospitals, Community; D006801:Humans; D008197:Lymph Node Excision; D008327:Mammography; D015411:Mastectomy, Modified Radical; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data / Q000639:trends; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009426:Netherlands; D010818:Practice Patterns, Physicians'; D012042:Registries; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome