Treatment of breast cancer in two teaching hospitals: a comparison with consensus guidelines

We compared the initial treatment of 383 patients with breast cancer in two central London teaching hospitals during 1986 with the guidelines of the King's Fund Consensus Conference for breast cancer treatment held in London the same year. The majority of patients (68%) received lumpectomy and 18% received mastectomy. Lumpectomy was followed by radiotherapy for 95% of cases but 30% of mastectomy patients also received radiotherapy. Only 42% of the patients had surgical sampling of the axillary nodes. Cytotoxic chemotherapy was recorded for 27% women under 50, but also for 16% women age 50 or more. Tamoxifen was given to 58% of women aged 50 or more, but also to 26% of women under 50. We conclude that there are discrepancies between consensus guidelines and clinical practice. Further study is needed to determine whether these variations are clinically important, and whether similar variations exist elsewhere in Europe.