VARIATION IN USE OF BREAST-CONSERVING SURGERY IN LOMBARDIA, ITALY

The extent of variation in the use of breast-conserving surgery was an alyzed using the 1990 and 1991 hospital discharge data of Lombardia, I taly. The proportion of patients undergoing breast-conserving surgery for unilateral breast cancer was estimated for each of the 10 geograph ic areas (9 provinces plus metropolitan Milano) in which the region is divided. Overall, the rate of use was 41% of 3,225 patients in 1990, and 45% of 3,736 patients in 1991. In both study years, patient age wa s strongly correlated with the likelihood of undergoing conservative s urgery, with younger women more frequently treated with this approach. In each province, patients treated at centers located in the main cit y had a greater probability (OR, 1.54; 95% GI, 1.37-1.69) of having co nservative surgery. This procedure was also more often used in private hospitals (OR, 1.59; 95% CI, 1.20-2.08) where care is paid at the poi nt of consumption by patients, directly or through their private insur ance. The observed variation in the use of the conservative procedure across the 10 regional areas was greater than that expected by chance alone (p < .0001), with rates ranging from 29% to 60%. This pattern pe rsisted even after adjusting for the relevant patient and hospital cha racteristics. Despite the relatively large body of scientific evidence , it appears that the surgical management of breast cancer is more dep endent on physicians' attitudes in each geographic area than on indivi dual patients' characteristics.