Diffusion of breast conserving surgery in medical communities.
Excluding skin cancers, breast cancer is the most common form of cancer in women. Due to an increased focus on early detection, many more cases of breast cancer are now diagnosed at an early stage, which makes the use of breast conserving surgery (BCS) an efficacious and often more desirable treatment choice than mastectomy. An analysis of the variation in the use of BCS in the United States was performed using data from the years 1988 and 1994, and stratifying hospitals on the basis of teaching status. In both 1988 and 1994, BCS was highest in academic teaching hospitals and lowest in community hospitals. This finding is interpreted within the framework of classical diffusion theory. Social and cultural norms in local medical communities have a strong effect on the degree to which innovations diffuse rapidly or not. This analysis is useful in the understanding of geographic and hospital-based variations in treatment for early stage breast cancer and other illnesses that have long and strongly held traditions of treatment.
School of Nursing, University of Virginia, P.O. Box 800782, Charlottesville, VA 22908-0782, USA.
Bonnie
B
Jerome-D'Emilia
James W
JW
Begun
D000046:Academic Medical Centers / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy / Q000706:statistics & numerical data / Q000639:trends; D004059:Diffusion of Innovation; D042241:Early Diagnosis; D005260:Female; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data* / Q000639:trends; D009367:Neoplasm Staging; D010348:Patient Care Team / Q000706:statistics & numerical data; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data / Q000639:trends; D012044:Regression Analysis; D014481:United States; D014600:Utilization Review / Q000706:statistics & numerical data