The effect of legislative requirements on the use of breast-conserving surgery

被引:48
作者
Nattinger, AB
Hoffmann, RG
Shapiro, R
Gottlieb, MS
Goodwin, JS
机构
[1] MED COLL WISCONSIN,DEPT BIOSTAT,MILWAUKEE,WI 53226
[2] MED COLL WISCONSIN,DEPT BIOETH,MILWAUKEE,WI 53226
[3] MED COLL WISCONSIN,DEPT FAMILY & COMMUNITY MED,MILWAUKEE,WI 53226
[4] UNIV TEXAS,MED BRANCH,DEPT MED,GALVESTON,TX 77550
关键词
D O I
10.1056/NEJM199610033351407
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background We studied the effect of state legislation requiring the disclosure of options for the treatment of breast cancer on the use of breast-conserving surgery in clinical practice. Methods The National Cancer Institute's Surveillance, Epidemiology, and End Results registry provided data on women from 30 through 79 years of age who underwent breast-conserving surgery or mastectomy for local or regional breast cancer from 1983 through 1990. We examined the trend over time in the use of breast-conserving surgery among patients in four sites (Connecticut, Iowa, Seattle, and Utah) where there were no state laws specifically requiring the disclosure of options for the treatment of breast cancer by physicians. For four additional sites (Detroit, Atlanta, New Mexico, and Hawaii) that had such legislation, we determined whether the rate of breast-conserving surgery after the legislation was different from the expected rate. Results An attorney rated the legislation as giving most direction to physicians in Michigan, followed by Hawaii, Georgia, and New Mexico. The rate of breast-conserving surgery was up to 8.7 percent higher than expected in Detroit for six months after the passage of the Michigan law (P<0.01). The rate was up to 13.2 percent higher than expected in Hawaii for 12 months after that state's law was passed (P<0.05) and up to 6.0 percent higher than expected in Atlanta for 3 months after the passage of the Georgia law (P<0.01). After these transient increases, the surgery rates reverted to the expected levels, No significant effect was detected in New Mexico, where only a resolution without legal force was passed. Conclusions Legislation requiring physicians to disclose options for the treatment of breast cancer appeared to have only a slight and transient effect on the rate of use of breast-conserving surgery, (C) 1996, Massachusetts Medical Society.
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页码:1035 / 1040
页数:6
相关论文
共 30 条
[1]  
ADAY LA, 1993, EVALUATING MED CARE, P49
[2]   BREAST-CANCER - THE TREATMENT OF CHOICE [J].
ANNAS, GJ .
HASTINGS CENTER REPORT, 1980, 10 (02) :27-29
[3]  
*BUR HLTH PROF, 1992, AR RES FILE ARF SYST
[4]   MULTIPLE COMPARISONS FOR RELATIVE RISK REGRESSION - EXTENSION OF THE K-RATIO METHOD [J].
DIXON, DO ;
DIVINE, GW .
STATISTICS IN MEDICINE, 1987, 6 (05) :591-597
[5]   GEOGRAPHIC-VARIATION IN THE TREATMENT OF LOCALIZED BREAST-CANCER [J].
FARROW, DC ;
HUNT, WC ;
SAMET, JM .
NEW ENGLAND JOURNAL OF MEDICINE, 1992, 326 (17) :1097-1101
[6]   5-YEAR RESULTS OF A RANDOMIZED CLINICAL-TRIAL COMPARING TOTAL MASTECTOMY AND SEGMENTAL MASTECTOMY WITH OR WITHOUT RADIATION IN THE TREATMENT OF BREAST-CANCER [J].
FISHER, B ;
BAUER, M ;
MARGOLESE, R ;
POISSON, R ;
PILCH, Y ;
REDMOND, C ;
FISHER, E ;
WOLMARK, N ;
DEUTSCH, M ;
MONTAGUE, E ;
SAFFER, E ;
WICKERHAM, L ;
LERNER, H ;
GLASS, A ;
SHIBATA, H ;
DECKERS, P ;
KETCHAM, A ;
OISHI, R ;
RUSSELL, I .
NEW ENGLAND JOURNAL OF MEDICINE, 1985, 312 (11) :665-673
[7]   CHANGING PHYSICIANS PRACTICES [J].
GRECO, PJ ;
EISENBERG, JM .
NEW ENGLAND JOURNAL OF MEDICINE, 1993, 329 (17) :1271-1274
[8]   THE 2 CULTURES OF BIOMEDICINE - CAN THERE BE CONSENSUS [J].
GREER, AL .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1987, 258 (19) :2739-2740
[9]   LIMITED SURGERY AND RADIOTHERAPY FOR EARLY BREAST-CANCER [J].
HARRIS, JR ;
HELLMAN, S ;
KINNE, DW .
NEW ENGLAND JOURNAL OF MEDICINE, 1985, 313 (21) :1365-1368
[10]  
JENKINS GM, 1979, PRACTICAL EXPERIENCE, P104