This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Hébert-Croteau, N.
Right arrow Articles by Deschênes, L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Hébert-Croteau, N.
Right arrow Articles by Deschênes, L.
Related Collections
Right arrow Health services research
Right arrow Guidelines
Right arrow Breast Cancer
Right arrow Radiation Oncology
CMAJ • October 19, 1999; 161 (8)
© 1999 Canadian Medical Association or its licensors

Evidence
Études

Variations in the treatment of early-stage breast cancer in Quebec between 1988 and 1994

Nicole Hébert-Croteau, MD, PhD*, Jacques Brisson, MD, ScD{dagger}{ddagger}, Jean Latreille, MDCM, Caty Blanchette, MSc{dagger} and Luc Deschênes, MD{ddagger}§

From *the Direction de santé publique, Régie régionale de la santé et des services sociaux de Montréal-centre, Montreal, Que.; {dagger}the Groupe de recherche en épidémiologie de l'Université Laval, Quebec City, Que.; {ddagger}the Centre des maladies du sein and the §Département de chirurgie, Hôpital du Saint-Sacrement, Quebec City, Que.; and ¶the Centre d'oncologie, Hôpital Charles-Lemoyne, Greenfield Park, Que.

Abstract

Background: The influence of organizational factors on the process and outcomes of the treatment of breast cancer has been extensively investigated. Although the quality of care is presumed to be better in larger centres, evidence is inconsistent. This study was conducted to determine whether therapies for patients with breast cancer varied according to hospital caseload.

Methods: Women newly diagnosed between 1988 and 1994 with early-stage node-negative primary breast cancer were randomly selected from the Quebec tumour registry and the Quebec hospital discharge database. Data were collected from medical charts, and only women having undergone dissection of the axilla were included in the analyses. Logistic regression analysis was used to adjust for case mix and organizational variables.

Results: The final sample included 1259 patients with node-negative stage I or II primary breast cancer. The proportion of women who underwent breast-conserving surgery increased significantly with hospital caseload (from 78.0% in hospitals admitting fewer than 25 new cases each year to 88.0% in those admitting 100 patients or more; p for trend < 0.001). This trend remained significant even after statistical adjustment for case mix and organizational factors (p for trend = 0.001). Of the 1039 women who underwent breast-conserving surgery 965 (92.9%) received radiotherapy. Use of systemic adjuvant therapy (tamoxifen or chemotherapy, or both) increased with the number of patients treated in a given centre (from 60.1% to 68.5%), but this trend disappeared after adjustment for case mix and other factors. The proportion of patients receiving systemic adjuvant therapy consistent with published consensus guidelines tended to increase with caseload for those treated in hospitals participating in multicentre clinical trials but decrease with caseload for patients in hospitals not involved in clinical research.

Interpretation: The care of patients in Quebec with early-stage breast cancer is characterized by a high prevalence of both breast-conserving surgery and systemic adjuvant therapy. Large centres, especially those actively involved in clinical research, rapidly adopt innovative therapeutic modalities.




This article has been cited by other articles:


Home page
 CMAJHome page
E. Grunfeld
Canadian breast cancer guidelines are as effective as possible under the circumstances
Can. Med. Assoc. J., March 13, 2007; 176(6): 785 - 786.
[Full Text] [PDF]

Home page
 JCOHome page
W. J. Temple, M. L. Russell, L. L. Parsons, S. M. Huber, C. A. Jones., J. Bankes, and M. Eliasziw
Conservation Surgery for Breast Cancer As the Preferred Choice: A Prospective Analysis
J. Clin. Oncol., July 20, 2006; 24(21): 3367 - 3373.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
M. Drolet, E. Maunsell, J. Brisson, C. Brisson, B. Masse, and L. Deschenes
Not Working 3 Years After Breast Cancer: Predictors in a Population-Based Study
J. Clin. Oncol., November 20, 2005; 23(33): 8305 - 8312.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
N. Hebert-Croteau, J. Brisson, J. Latreille, M. Rivard, N. Abdelaziz, and G. Martin
Compliance With Consensus Recommendations for Systemic Therapy Is Associated With Improved Survival of Women With Node-Negative Breast Cancer
J. Clin. Oncol., September 15, 2004; 22(18): 3685 - 3693.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
J. L. Malin, M. A. Schuster, K. A. Kahn, and R. H. Brook
Quality of Breast Cancer Care: What Do We Know?
J. Clin. Oncol., November 1, 2002; 20(21): 4381 - 4393.
[Abstract] [Full Text] [PDF]

Home page
 CMAJHome page
R. Chaudhry, V. Goel, and C. Sawka
Breast cancer survival by teaching status of the initial treating hospital
Can. Med. Assoc. J., January 1, 2001; 164(2): 183 - 188.
[Abstract] [Full Text] [PDF]