Predictors of state-of-the-art management of early breast cancer in Switzerland.
BACKGROUND
The aim of this study was to investigate predictors of state-of-the-art management of early breast cancer in Switzerland.


METHODS
The study included 3499 women aged 25-79 years diagnosed with invasive breast cancer stages I-IIIA in 2003-2005. Patients were identified through population-based cancer registries and treated in all kinds of settings. Concordance with national and international recommendations was assessed for 10 items covering surgery, radiotherapy, systemic adjuvant therapy and histopathology reporting. We used multivariate logistic regression to identify independent predictors of high (10 points) and low (≤7 points) concordance.


RESULTS
In one-third of the patients, management met guidelines in all items, whereas in about one-fifth, three or more items did not comply. Treatment by a surgeon with caseload in the upper tercile and team involved in clinical research were independent predictors of a high score, whereas treatment by a surgeon with a caseload in the lower tercile was associated with a low score. Socioeconomic characteristics such as income and education were not independent predictors, but patient's place of residence and age independently predicted management according to recommendations.


CONCLUSIONS
Specialization and involvement in clinical research seem to be key elements for enhancing the quality of early breast cancer management at population level.
Ess
S
S
Cancer Registry St Gallen-Appenzell, Cancer League St. Gallen-Appenzell, St Gallen. Electronic address: silvia.ess@kssg.ch.
Joerger
M
M
Cancer Registry St Gallen-Appenzell, Cancer League St. Gallen-Appenzell, St Gallen; Oncology Department, Cantonal Hospital St Gallen, St Gallen.
Frick
H
H
Cancer Registry Grison-Glarus and Department of Pathology, Cantonal Hospital Graubünden, Chur.
Probst-Hensch
N
N
Cancer Registry Zurich (former); Swiss Tropical and Public Health Institute, University of Basel, Basel.
Vlastos
G
G
Senology Unit, Geneva University Hospitals, Geneva.
Rageth
C
C
Brust-Zentrum Seefeld, Zurich.
Lütolf
U
U
Department of Radio-Oncology, Zurich University Hospital, Zurich.
Savidan
A
A
Cancer Registry St Gallen-Appenzell, Cancer League St. Gallen-Appenzell, St Gallen.
Thürlimann
B
B
Breast Center, Cantonal Hospital St Gallen, St Gallen, Switzerland.
D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology / Q000628:therapy*; D019468:Disease Management; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D012423:Rural Health; D012923:Social Class; D013557:Switzerland; D016896:Treatment Outcome