Breast conservation therapy in affiliated county, university, and private hospitals

BACKGROUND: Breast conservation therapy (BCT) offers equivalent survival to modified radical mastectomy in patients with early-stage (I and IIa) breas t cancer, but is utilized in less than 50% of eligible patients. While pati ent demographics have been linked to BCT rates, we suspected that physician influence was a major factor. The purpose of this study was to compare BCT at three affiliated centers staffed by similarly trained surgeons yet serv ing widely disparate populations, in order to assess the importance of phys ician influence on the utilization of BCT, METHODS: Tumor registry data were reviewed from 1993 through 1997 at affili ated city/county (CH), university (UH), and private hospitals (PH). Data we re analyzed for clinical stage, treatment, and age of patient. RESULTS: The utilization of BCT for stage I and IIa breast cancer is simila r at the three hospitals: 45% of patients at CH, 55% of patient at UH, and 57% of patients at PH (P > 0.05). Rates of BCT were similar across all pati ent age groups at all sites. CONCLUSIONS: Similar BCT utilization rates can be achieved despite widely d isparate patient populations. The three affiliated hospitals are staffed by surgeons with similar training, and all offer a multidisciplinary approach to breast cancer care. This suggests that physician influence may override patients' socioeconomic issues in providing optimal breast cancer therapy. Am J Surg. 1999;178:466-469, (C) 1999 by Excerpta Medica, Inc.