title: A decade of change: an institutional experience with breast surgery in 1995 and 2005.
abstract: BACKGROUND
  With the adoption of routine screening mammography, breast cancers are being diagnosed at earlier stages, with DCIS now accouting for 22.5% of all newly diagnosed breast cancers. This has been attributed to both increased breast cancer awareness and improvements in breast imaging techniques. How have these changes, including the increased use of image-guided sampling techniques, influenced the clinical practice of breast surgery?
  
  
  METHODS
  The institutional pathology database was queried for all breast surgeries, including breast reconstruction, performed in 1995 and 2005. Cosmetic procedures were excluded. The results were analysed utilizing the Chi-square test.
  
  
  RESULTS
  Surgical indications changed during 10-year study period, with an increase in preoperatively diagnosed cancers undergoing definitive surgical management. ADH, and to a lesser extent, ALH, became indications for surgical excision. Fewer surgical biopsies were performed for indeterminate abnormalities on breast imaging, due to the introduction of stereotactic large core biopsy. While the rate of benign breast biopsies remained constant, there was a higher percentage of precancerous and DCIS cases in 2005. The overall rate of mastectomy decreased from 36.8% in 1995 to 14.5% in 2005. With the increase in sentinel node procedures, the rate of ALND dropped from 18.3% to 13.7%. Accompanying the increased recognition of early-stage cancers, the rate of positive ALND also decreased, from 43.3% to 25.0%.
  
  
  CONCLUSIONS
  While the rate of benign breast biopsies has remained constant over a recent 10-year period, fewer diagnostic surgical image-guided biopsies were performed in 2005. A greater percentage of patients with breast cancer or preinvasive disease have these diagnoses determined before surgery. More preinvasive and Stage 0 cancers are undergoing surgical management. Earlier stage invasive cancers are being detected, reflected by the lower incidence of axillary nodal metastases.
authors.affiliation: Departments of Surgery.
authors.forename: Amber A
authors.initials: AA
authors.lastname: Guth
authors.forename: Beth Ann
authors.initials: BA
authors.lastname: Shanker
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Roses
authors.forename: Deborah
authors.initials: D
authors.lastname: Axelrod
authors.forename: Baljit
authors.initials: B
authors.lastname: Singh
authors.forename: Hildegard
authors.initials: H
authors.lastname: Toth
authors.forename: Richard L
authors.initials: RL
authors.lastname: Shapiro
authors.forename: Karen
authors.initials: K
authors.lastname: Hiotis
authors.forename: Thomas
authors.initials: T
authors.lastname: Diflo
authors.forename: Joan F
authors.initials: JF
authors.lastname: Cangiarella