et al., 1992; Samet et al., 1994). Although the proportion of women who would undergo breast conserving surgery if all eligible women were offered the procedure is not known, the wide regional variations could indicate variation in the quality of breast cancer care (i.e., women not offered choice of procedure by their provider).

TABLE 4.4

Target and Observed Care in 1989-1991 in Virginia BC/BS Women Age <65

Issue

Expert Target (%)a

BC/BS Cohort (%)a

Evaluation

Initial biopsy prior to total mastectomyb

>95

92

Treatment

Axillary node dissection

>90

88c

Breast conserving surgery for local disease

50

33

Local breast radiation following lumpectomy

>95

86

Staging

Perioperative (within 30 days) bone scan

<10

34

Perioperative (within 30 days) abdominal CT scan

<10

12

Adjuvant Chemotherapy

If premenopausal and >1 axillary node (+), receive chemotherapy,

>90

83

If postmenopausal and >1 axillary node (+), receive chemotherapyd

50

52

Referral

 

 

At least one visit to a medical oncologist to discuss adjuvant therapy

>80

56

If mastectomy, at least one visit to a plastic surgeon to discuss reconstructive surgery

>60

27

Follow-Up

 

 

Mammography within the first 18 months postoperatively

>95

79

Bone or CT scans for suspicious symptoms per year

<15

18-35

NOTE: CT = computed tomography.

a BC/BS cohort used local and regional summary staging.

b Biopsy could be aspiration cytology, core biopsy, or excisional biopsy prior to total mastectomy. A two-step surgical procedure is not implied.

c Based on axillary nodes reported to registry of those patients with summary staging; 11% of women with breast cancer were excluded since no staging data were reported.

d Chemotherapy only. Use of hormonal therapy could not be assessed.

SOURCE: Hillner et al., 1997.



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