To analyse the extent of variation by county and hospital in the use of breast-conserving surgery in the initial management of breast cancer and to assess some factors that might explain the observed variation.Design
Population-based retrospective cohort study.Setting
All women with breast cancer newly diagnosed from Jan. 1, 1989, to Dec. 31, 1991.Main outcome measure
Proportion of women undergoing unilateral breast cancer surgery who had breast-conserving surgery in each hospital and county.Results
Of the 14 570 women with newly diagnosed breast cancer 12 815 (88.0%) underwent unilateral breast cancer surgery. The mean proportion of breast-conserving procedures by county was 52% and ranged from 11% to 84%. The proportion of breast-conserving procedures in individual hospitals with one or more cases of breast cancer per month ranged from 6% to 84%. The variations in the rates between hospitals was greater than that expected by chance alone (p 0.0001).Conclusions
There was marked variation at the hospital and county level in the use of breast-conserving surgery in the initial management of breast cancer. This variation was strongly associated with the hospital where the surgery was performed.