Management of Breast Cancer in Southeast England

Objective: To examine the extent to which management of invasive breast cancer reflected consensus guidelines in the Thames regions in 1990.

Design: Population based study of case notes.

Setting: Thames Cancer Registry.

Subjects: All women with breast cancer diagnosed in early 1990 (417 cases) resident in the four Thames regions. Hospital records were traced for 346 cases, of which 12 were ineligible because of misclassification in initial registration and were excluded from the analysis. 334 cases were analysed.

Main Outcome Measures: Investigations and treatment in the six months after diagnosis, stage of disease.

Results: Of the 334 women identified, 86 were aged under 50. Three years after diagnosis, 74 were dead, seven (8%) aged under 50 and 67 (27%) aged 50 or over. Axillary surgery was used to stage cancer in only 155 cases (46%), although this is recommended in the guidelines. Only 79 (24%) case notes had any information recorded on stage. Stage could be determined reliably for only half of the sample. Treatment varied widely within the same age group and stage of disease. In particular, chemotherapy was not routinely given to patients under 50 with stage II disease. Only 17 records showed evidence that the patient was participating in a clinical trial.

Conclusions: There was a lack of consensus on the management of breast cancer among clinicians in 1990. More patients should be included in clinical trials.