Changing practice in systemic breast cancer adjuvant treatment in a well-defined French population

Using the 2,208 non metastatic breast cancer diagnosed women who underwent breast surgery from the 2, 432 first breast cancers recorded by the French departement of Cote-d'Or cancer registry from 1982 to 1992, we described in this well-defined population, the trend in breast-cancer adjuvant treatmen t, and related practices with recommendations according to risk groups. Adj uvant treatment was received by 44.1% of the 2,208 women. Inflammatory tumo rs were systematically treated with chemotherapy. For the noninflammatory M 0 breast-cancer (2,167 women), the adjuvant treatment probability was mainl y determined by the nodal involvement. After adjustment on the tumor- and h ost-characteristics, time period was associated with increased probability of adjuvant treatment in the whole group of patients and within each pN sub group. In the group without nodal involvement, this increase was also assoc iated with the SBR histologic grade. There was strong evidence of large cha nges in breast-cancer adjuvant treatment. Clinical practices in the Cote-d' Or region have paralleled the NIH recommendations. For node-negative breast cancers, these trends appeared despite persistent uncertainty in the defin ition of subgroups to treat Over time, the SBR histologic grade became an a pparent factor of treatment. This use as a treatment indicator was done wit hout validation in any adjuvant treatment trial. The simultaneous recommend ation to treat with the absence of guidelines could lead to the treating of an increasingly large group by extending the "high-risk" definition. This could be a nan-optimal management of risk while putting strain on health ca re resources.