Changing attitudes towards breast-conserving treatment of early breast cancer in the south-eastern Netherlands: results of a survey among surgeons and a registry-based analysis of patterns of care

To see whether personal preferences of surgeons can explain the trends in the use of breast-conserving therapy (BCT) of early breast cancer, questionnaires were sent to the surgeons of seven community hospitals in the south-eastern Netherlands in 1987 and 1995. The answers were set against the actual use of breast-conserving therapy in the hospitals in the period 1984–94, as monitored by the Eindhoven Cancer Registry. The proportion of surgeons who were willing to use BCT for tumours less-than-or-equals, slant 3 cm increased from 43% in 1987 to 93% in 1995. In 1995, the majority of the surgeons considered multicentric tumour growth, diffuse microcalcifications on the mammogram and an extensive intraductal component around the tumour as contraindications for breast-conserving therapy. The proportion of patients with an operable, non-metastasized breast tumour of less-than-or-equals, slant5 cm in diameter undergoing breast-conservative surgery increased from 31% in 1984 to 60%/) in 1989 (P<0.01) and remained at that level in 1990 and 1991. Between 1991 and 1993, the proportion receiving breast-conservative surgery decreased significantly for patients younger than 50 years and a tumour 2.1–3.0 cm in diameter, and also for those 50–69 years old with a tumour ≤ 2.0 cm or 3.1–5.0 cm across. The observed decrease in BCT in the south-eastern Netherlands in some subgroups seems to reflect the growing awareness of potential risk factors for local recurrence following BCT.