Breast conservation: Trends in a major southern metropolitan area comparedwith surrounding rural counties

Despite randomized prospective studies and National Institutes of Health re commendations, surgeons especially in the southern United States have been slow to adopt breast conservation surgery (BCS). Data were analyzed regardi ng 3349 cases of stage 0, 1, and II breast cancer (1991-1998) from Charlott e-Mecklenburg County, NC; 1057 cases from six surrounding rural counties (1 995-1997); and 90,398 cases (1995) from the National Cancer Data Base. Duri ng 1995 through 1997 Charlotte-Mecklenburg County had statistically signifi cantly higher rates of BCS compared with six surrounding rural counties for stage I (59% and 42% respectively, P = 0.001) and stage II (37% and 19%, r espectively, P = 0.001) breast cancer. The BCS rates in Charlotte-Mecklenbu rg County (1991-1998) showed the following: Stage 0 rate increased from 17 per cent in 1991 to 78 per cent in 1998 (P = 0.001), stage I rate increased from 31 per cent in 1991 to 65 per cent in 1998 (P = 0.001), and stage II rate increased from 18 per cent in 1991 to 42 per cent in 1998 (P = 0.001). BCS rates for early-stage breast cancer in Charlotte-Mecklenburg County ha ve increased over the last 8 years and now equal national rates; however, p atients in surrounding rural counties are not receiving BCS as frequently. There is a need for more widespread education of surgeons, other health car e providers, and the general public to increase the use of BCS.