The quality of early-stage breast cancer care

Objective To assess whether recent practice has improved, the authors created detaile d, evidence-based guidelines and assessed the quality of early-stage breast cancer care at four hospitals in the metropolitan New York area. Summary Background Data Adjuvant treatments for early-stage breast cancer have been shown to improv e health and longevity. However, reports from the 1980s showed marked under use of these therapies. Methods All 723 women with early-stage breast cancer who had a definitive surgical procedure at four participating hospitals in the Mount Sinai-NYU Health Sys tem between April 1994 and August 1996 were included. Inpatient and outpati ent records were abstracted. Results Fifty-nine percent of women underwent breast-conserving surgery, of whom 81 % received radiation therapy. Hospital-specific radiation therapy rates var ied from 69% to 87%. Seventy-eight percent of women with stage 1B or greate r cancer received systemic treatment, with hospital-specific rates varying from 71% to 86%. Between 18% and 33% of women who could have benefited from local or systemic adjuvant treatments did not receive them. The risk of no t getting a beneficial adjuvant treatment varied more than twofold by the h ospital where the breast cancer surgery was performed. Conclusions The hospital where breast cancer surgery is performed is associated with th e likelihood that women receive effective local and systemic adjuvant treat ments. Surgeons and members of hospital quality improvement programs should encourage multidisciplinary approaches to breast cancer care.