title: Breast conservation rates-barriers between tertiary care and community practice.
abstract: OBJECTIVE
  Low rates of breast conservation therapy (BCT) are reported in the southern United States. We evaluated the influence on BCT rates of opening a radiotherapy (RT) clinic at a community hospital in North Carolina. Before opening, RT was available 5 miles away at a tertiary care center.
  
  
  METHODS
  A review of the pathology database of the community hospital identified patients who underwent definitive surgery for invasive breast malignancy or ductal carcinoma in situ between 1994 and 1995, and 1997 and 1998, before and after the opening of the RT clinic in 1996. From these data, the mode of therapy, mastectomy or BCT, was determined. The results were compared using logistic regression analysis. Surgical and RT physician staffing were unchanged throughout the study period.
  
  
  RESULTS
  A total of 586 patients was evaluated. The BCT rate at the community hospital for 1994-1995 and 1997-1998 was 29% and 44%, respectively. On both univariate and multivariate logistic regression analysis, the era of treatment was statistically significant in its impact on the procedure performed (p <0.001).
  
  
  CONCLUSIONS
  The use of BCT increased at a community hospital after the opening of an on-site RT facility, even though RT was available 5 miles away previously.
authors.affiliation: Duke University Medical Center, Durham, NC 27710, USA. hahn@radonc.duke.edu
authors.forename: Carol A
authors.initials: CA
authors.lastname: Hahn
authors.forename: Lawrence B
authors.initials: LB
authors.lastname: Marks
authors.forename: David Y
authors.initials: DY
authors.lastname: Chen
authors.forename: Pehr A
authors.initials: PA
authors.lastname: Lind
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Lind
authors.forename: Leonard R
authors.initials: LR
authors.lastname: Prosnitz
mesh_terms: D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006297:Health Services Accessibility; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D015411:Mastectomy, Modified Radical / Q000706:statistics & numerical data; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data*; D009657:North Carolina / Q000453:epidemiology; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data*; D012189:Retrospective Studies