The operative management of screen-detected breast cancers

Background: Mammographic screening for breast cancer not only reduces the o verall mortality from breast cancer but allows greater opportunities for br east-conserving operations. The predicted degree of breast conservation is not being realized, but is increasing in centres that have published their results. Methods: The operative management of breast cancers diagnosed by BreastScre en Central and Eastern Sydney Screening and Assessment Service were compare d between two time periods: January 1988-December 1992 (group 1) and Januar y 1993-December 1995 (group 2). The rate of breast conservation, and other data were compared between the two periods. An attempt was made with multiv ariate analysis to identify some of the factors that made mastectomy rather than conservation more likely. Results: There were 723 cancers detected that were suitable for analysis (g roup 1, n = 273; group 2, n = 450). In group 1 the breast conservation rate was 42.9%; this increased significantly to 60.4% in group 2 (P < 0.001). T he data were examined to determine if there was any other factor that had c hanged over the time periods which might account for the increased rate of breast conservation. The use of pre-operative diagnostic techniques such as fine needle aspirate cytology and core biopsy increased significantly. Mul tivariate analysis comparing the differences in patient age, diagnostic tec hnique, tumour type, grade, size, location and lymph node status, both inde pendently and compositely did not account for the increase in breast conser vation in group 2. Conclusion: The increase in breast conservation is due to other factors suc h as the surgeons' approach and patient attitude. The use of pre-operative, minimally invasive tissue sampling techniques is increasing.