CHANGE IN THE USE OF BREAST-CONSERVING SURGERY IN WESTERN WASHINGTON AFTER THE 1990 NIH-CONSENSUS-DEVELOPMENT-CONFERENCE

Objective: To evaluate the use of breast-conserving surgery in western Washington before and after the National Institutes of Health Consens us Development Conference (June 18-21, 1990) during which breast-conse rving surgery was recommended for most women with early invasive breas t cancer. Design:Survey. Setting: Population-based cancer registry in the Seattle-Puget Sound (Washington) region. Participants: The survey included 13 541 women in whom American Joint Committee on Cancer stage I or II breast cancer was diagnosed between January 1, 1983, and Dece mber 31, 1993. Main Outcome Measure: Proportion of participants who un derwent breast-conserving surgery. Results: From April 1985, after res ults of a US randomized controlled trial showing equivalent survival i n women undergoing mastectomy or breast-conserving surgery were publis hed, to the time of the Conference, breast-conserving surgery was perf ormed on 44.8% of women with stage I and 25.8% with stage II breast ca ncer. These percentages increased to 54.9% and 35.2%, respectively, du ring the post-Conference period. While women with stage II breast canc er were less likely than women with stage I breast cancer to undergo b reast-conserving surgery before and after the Conference, trends for a ge and education were attenuated after the Conference. Differences in the use of breast-conserving surgery observed before the Conference be tween counties of residence and among hospital types were also reduced after the Conference. Conclusions: These findings suggest that the Co nference recommendations had an effect on the adoption of breast-conse rving surgery, particularly among groups who were previously least lik ely to undergo such surgery. Despite progress toward the Conference re commendation that the majority of women with early invasive breast can cer undergo breast-conserving surgery, the majority of women with stag e II breast cancer undergo mastectomy.