title: Changes in mastectomy rates at a Brazilian public hospital over 20 years (1989 to 2008).
abstract: OBJECTIVE
  Recently, breast-conserving surgery (BCS) has been replacing mastectomy for breast cancer treatment. The aim of this study was to evaluate the changes in mastectomy and BCS rates and the factors relating to these shifts.
  
  
  METHODS
  A retrospective study in a Brazilian public hospital.
  
  
  METHODS
  Pathological records from female patients who underwent surgery for breast cancer at Hospital das Clínicas, Universidade Federal de Minas Gerais (HC-UFMG), between 1989 and 2008 were reviewed. The mastectomy and BCS rates were calculated. The chi-square test was used to assess factors associated with type of surgical treatment and to compare trends in treatment type over the years. Logistic regression was used for multivariate analysis.
  
  
  RESULTS
  From 1989 to 2008, 2050 breast cancer surgical specimens were received in our service, corresponding to 1973 patients; 1324 (64.6%) of them were from mastectomy and 726 (35.4%) from BCS. A shift from mastectomy towards BCS was observed (P < 0.001). In multivariate analysis, earlier year of surgery (P < 0.001), larger tumor size (P < 0.001), having at least one positive axillary lymph node (P < 0.001) and patients' age greater than 68 years (P = 0.007) were predictors of mastectomy.
  
  
  CONCLUSIONS
  There was a shift from mastectomy towards BCS in our institution over the years. This may reflect consolidation of BCS (plus radiotherapy) as an equivalent treatment to mastectomy in terms of survival and a shift to earlier diagnosis for the disease.
authors: Department of Anatomical Pathology, Universidade Federal de Minas Gerais, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
authors: Débora
authors: D
authors: Balabram
authors: Fábio Braga
authors: FB
authors: Araújo
authors: Simone Souza
authors: SS
authors: Porto
authors: Joyce Soares
authors: JS
authors: Rodrigues
authors: Atila Silva
authors: AS
authors: Sousa
authors: Arminda Lucia
authors: AL
authors: Siqueira
authors: Helenice
authors: H
authors: Gobbi
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D004812:Epidemiologic Methods; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D008408:Mastectomy / Q000706:statistics & numerical data* / Q000639:trends; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data / Q000639:trends; D008875:Middle Aged; D009367:Neoplasm Staging; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult