Temporal Trends in Breast Cancer Surgery in Ontario: Can One Randomized Trial Make a Difference?

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ObjectiveTo 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.DesignRetrospective cohort study.SettingAll hospitals in Ontario.PatientsA 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 measureThe most invasive surgical procedure used within 90 days of diagnosis.ResultsUnilateral 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.ConclusionOne randomized clinical trial can have an immediate and profound effect on medical practice.

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