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[Quality of treatment in operable breast carcinoma. Comparison of the years before 1987, 1987-1990 and 1991-1994].

BACKGROUND
Has progress in the treatment of breast cancer been translated into routine practice? What can be further ameliorated? We present a first step in quality assurance by examining the quality of care in early-stage breast cancer during recent years.


METHODS
Retrospective analysis of actual care in 300 patients with operable invasive breast 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 diagnose smaller tumors in our series. The percentage of patients undergoing breast-conserving surgery has not increased since 1987. Overall, 25% of cancers were treated by breast-conserving surgery. The rate of ipsilateral 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 to many node negative patients. Combined adjuvant therapy (endocrine plus chemotherapy) was rarely used. Early consultation of medical oncology has increased in recent years.


CONCLUSION
Progress in the treatment 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 form of quality control is a multidisciplinary approach, which should be used early, in every case, and if necessary, repeatedly.