QUALITY OF TREATMENT IN OPERABLE BREAST-C ANCER

Background: Has progress in the treatment of breast cancer been transl ated into routine practice? What can be further ameliorated? We presen t a first step in quality assurance by examining the quality of care i n early-stage breast cancer during recent years. Methods: Retrospectiv e analysis of actual care in 300 patients with operable invasive breas t cancer. Analysis and comparison of treatment in 3 time-periods based on date of diagnosis (before 1987, 1987-1991, 1991-6/1994). Results: Staging, surgical treatment and histopathological analysis have become more complete over these years. There is, however, no tendency to dia gnose smaller tumors in our series. The percentage of patients undergo ing breast-conserving surgery has not increased since 1987. Overall, 2 5% of cancers were treated by breast-conserving surgery. The rate of i psilateral breast recurrences after breast-conserving surgery was 19% if the breast was irradiated, and 67% when radiation had been omitted (median follow-up 50 months). Adjuvant systemic therapy is now given t o many node negative patients. Combined adjuvant therapy (endocrine pl us chemotherapy) was rarely used. Early consultation of medical oncolo gy has increased in recent years. Conclusion: Progress in the treatmen t of early-stage breast cancer has only partially been translated into clinical practice. To ensure that treatment decisions conform to the most recent standards, quality controls are necessary. The simplest fo rm of quality control is a multidisciplinary approach, which should be used early, in every case, and if necessary, repeatedly.