TY - JOUR T1 - Temporal trends in breast cancer surgery in Ontario: can one randomized trial make a difference? JF - Canadian Medical Association Journal JO - CMAJ SP - 1109 LP - 1115 VL - 150 IS - 7 AU - N. A. Iscoe AU - C. D. Naylor AU - J. I. Williams AU - G. DeBoer AU - M. W. Morgan AU - G. Fehringer AU - E. Holowaty Y1 - 1994/04/01 UR - http://www.cmaj.ca/content/150/7/1109.abstract N2 - OBJECTIVE: To assess the effect of a single randomized clinical trial, the National Surgical Adjuvant Breast Project (NSABP) B-06, on the surgical management of breast cancer in women. DESIGN: Retrospective cohort study. SETTING: All hospitals in Ontario. PATIENTS: A consecutive sample of 37,447 women with breast cancer newly diagnosed from Jan. 1, 1980, to Dec. 31, 1989, linked to a surgical procedure record in the Ontario Cancer Registry. MAIN OUTCOME MEASURE: The most invasive surgical procedure used within 90 days of diagnosis. RESULTS: Unilateral breast-ablative surgery (BAS) was performed in 57.3% of the women and breast-conserving surgery (BCS) in 31.6%. The annual rate of BAS declined from 77.5% in 1980 to 44.2% in 1989 and the rate of BCS rose from 12.5% in 1980 to 43.5% in 1989. The decline was linear from 1980 to 1984 and then accelerated significantly in 1985 (p < 0.0001), after the results of the NSABP B-06 trial were published. CONCLUSION: One randomized clinical trial can have an immediate and profound effect on medical practice. ER -