title: What drove changes in the use of breast conserving surgery since the early 1980s? The role of the clinical trial, celebrity action and an NIH consensus statement.
abstract: BACKGROUND
  Three important events in the history of breast cancer treatment occurred between 1983 and 1995: a large clinical trial, first lady Nancy Reagan's choice of mastectomy and the publishing of an NIH consensus statement.
  
  
  OBJECTIVE
  To assess the effects of these events on use of breast conserving surgery (BCS).
  
  
  METHODS
  Data from the cohort study of the surveillance, epidemiology and end results (SEER) Program from 1983 to 1995 were divided into four periods: Baseline, Trial, Celebrity, and Consensus.
  
  
  METHODS
  Of the women, 169,466 diagnosed with early stage breast cancer in nine SEER areas.
  
  
  METHODS
  Monthly percentages of BCS.
  
  
  RESULTS
  A linear regression model generated a separate intercept and slope term for four time periods, adjusting for demographic characteristics of breast cancer patients. For the Baseline, Celebrity and Consensus Periods, slopes indicated an increasing use of BCS which varied between 0.24% and 0.28% per month. Slopes for these three periods were not statistically different (p = 0.120). In contrast, there was no change in use of BCS during the trial period (p = 0.247). We tested the magnitude of discontinuity between periods. At the beginning of the trial, celebrity and consensus periods, there were increases in BCS of 5.54% (p < 0.001), -3.55% (p < 0.001), and 2.37% (p < 0.001), respectively.
  
  
  CONCLUSIONS
  The use of BCS was substantially affected by the reports of a clinical trial of BCS and by celebrity action. These effects were abrupt but transient. The NIH consensus statement stimulated a small change in use of BCS and may be an important intervention for maintaining the increasing trend in use of BCS since the 1990s.
authors.affiliation: Department of Internal Medicine and Sealy Center on Aging, University of Texas Medical Branch, Galveston 77555-0460, USA. xdu@utmb.edu
authors.forename: X
authors.initials: X
authors.lastname: Du
authors.forename: D H
authors.initials: DH
authors.lastname: Freeman
authors.forename: D A
authors.initials: DA
authors.lastname: Syblik
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery*; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D015975:Consensus Development Conferences, NIH as Topic; D005260:Female; D006801:Humans; D007255:Information Services; D008402:Mass Media; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D011639:Public Opinion; D018426:SEER Program; D014481:United States