Abstract
Background
To describe variation in staging and primary treatment by hospital characteristics
including type and volume and region in patients with early breast cancer (BC) in
the Netherlands, 2003–2006 after completion of national guidelines in 2002.
Methods
All patients newly diagnosed with invasive BC in 2003–2006 and recorded in the Netherlands
Cancer Registry were included (n = 51 354). Multivariable logistic regression analyses examined the influence of patient
and hospital characteristics, also by region, on type of breast surgery, axillary
lymph node dissection (ALND), sentinel node procedure (SNP), and adjuvant irradiation
and/or systemic treatment.
Results
Patients <40 years more often underwent breast conserving surgery (BCS) in general
hospitals (OR 1.4 (95%CI 1.1–1.5)) than in teaching and academic hospitals, whereas
patients of 40–69 years less often received BCS in an academic hospital (OR 0.9 (95%CI
0.8–1.0)) than in teaching hospitals. Patients with pT1-2N0 cancer more often underwent
primary ALND in a general hospital than in a larger teaching or academic hospital.
Type of hospital did not seem to affect utilization of adjuvant systemic therapy,
but patient age and tumour size and grade did. Over time, patients more often received
SNP, BCS, and adjuvant systemic therapy, primary ALND being on the decline, but with
substantial regional variation between geographic regions.
Conclusion
With detailed evidence-based national guidelines since 2002 the considerable regional
and hospital variation in staging procedures and primary treatment among newly diagnosed
patients with early breast cancer in the Netherlands decreased markedly, suggesting
the presence of late adaptors rather than specific hospital characteristics.
Keywords
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Article info
Publication history
Accepted:
June 8,
2010
Footnotes
☆Study performed by the ‘Quality of cancer care’ taskforce of the Signalling Committee Cancer of the Dutch Cancer Society (the committees full report is available on www.kwfkankerbestrijding.nl).
Identification
Copyright
© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
