Surgical management of breast cancer in a small peripheral New Zealand hospital.
BACKGROUND
Peripheral hospitals are perceived to be at a disadvantage in providing treatment for breast cancer, especially with regard to breast conservative surgery (BCS) because of the requirement of adjuvant radiotherapy. Wairau Hospital is a 100-bed peripheral hospital in New Zealand with no on-site radiotherapy unit.


METHODS
A retrospective audit of the surgical management of breast cancer between 1998 and 2002 was carried out.


RESULTS
One hundred and fifty-seven presentations during the audit period. Despite the lack of tertiary resources, we report an overall BCS rate of 58.6%, consistent with the appropriate New Zealand guidelines. Of screen-detected cancers, 81.6% underwent BCS. Only five patients requested mastectomy and of those undergoing BCS, five patients refused subsequent adjuvant radiotherapy. This was because of frailty from age and comorbidities and the inconvenience of travel.


CONCLUSIONS
High rates of BCS are possible in peripheral hospitals. We postulate that intensive support and a visiting outpatient oncological service help empower patients to seek BCS if appropriate. A strong partnership between surgical, radiological and oncological services is also vital.
Lee
Don Wai Gin
DW
Department of General Surgery, Wairau Hospital, Nelson-Marlborough District Health Board, Blenheim, New Zealand. dwglee@yahoo.com.au
Vallance
Stephen
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000532:radiotherapy / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D006744:Hospital Bed Capacity, 100 to 299; D006764:Hospitals, Community / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008408:Mastectomy / Q000706:statistics & numerical data; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data; D008485:Medical Audit; D008875:Middle Aged; D009520:New Zealand; D018714:Radiotherapy, Adjuvant; D014600:Utilization Review