Trends in diagnosis and management of breast cancer in the U. S.: From the surveys of the american college of surgeons

Abstract

The results of a comparative study of a series of 15,132 cases of breast cancer diagnosed in 1972 and a series of 14,577 cases diagnosed in 1977 are presented. Data were collected through surveys of 670 hospitals in the United States conducted by the Commission on Cancer—American College of Surgeons. There has been significant improvement in the stage at which breast cancer is diagnosed in black patients. The proportion of cases diagnosed at the localized stage increased from 38.5% in the 1972 series to 45.2% in 1977. During the same time period, the average size of the tumor in black patients decreased from 4.5 cm to 3.5 cm and the average number of positive axillary nodes decreased from 6.6 to 5.5. Less change in the stage of disease at diagnosis or in the size of the tumor was observed in white patients and no significant change was found in the average number of positive axillary nodes. The average number of axillary nodes examined increased from 14.5 nodes to 16.0 nodes in white patients and from 16.4 to 17.3 in black patients. The proportion of all cases treated by surgery with axillary dissection increased from 79.8% in 1972 to 85.8% in 1977. Recent cases were more likely to be treated with surgery alone. Use of radiotherapy alone or in combination decreased for both races but the use of chemotherapy increased. A marked shift from Halsted radical mastectomy to modified radical mastectomy was evident at every level of age, stage of the disease, and size of tumor, and was observed in hospitals of all sizes. A significant increase in the average number of nodes examined was observed for each surgical procedure involving axillary dissection. No increase was observed in the use of conservative surgery (wedge excision, total mastectomy, or total mastectomy with low axillary dissection).