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Temporal trends in breast cancer surgery in Ontario: can one randomized trial make a difference?
N A Iscoe1, C D Naylor, J I Williams
1Toronto Bayview Regional Cancer Centre, Ontario Cancer Treatment and Research Foundation.
Objective:
To 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.
Design:
Retrospective cohort study.
Setting:
All hospitals in Ontario.
Patients:
A 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 Measure:
The most invasive surgical procedure used within 90 days of diagnosis.
Results:
Unilateral 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.
Conclusion:
One randomized clinical trial can have an immediate and profound effect on medical practice.
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