SURGICAL-MANAGEMENT OF BREAST-CANCER - EXPERIENCE OF THE CENTRAL-SYDNEY-AREA-HEALTH-SERVICE BREAST-X-RAY-PROGRAM, 1988-1991

Objective: To review the breast cancers detected in the first three years of the Central Sydney Area Health Service Breast X-ray Programme, their histopathology and their surgical management within the program. Design: Between March 1988 and March 1991, women screened in the program who had a suspicious lesion were referred for surgical assessment at the program assessment centre at Rachel Forster Hospital. These women were seen by staff of the assessment centre, including program surgeons, and were then treated at either Rachel Forster Hospital or Royal Prince Alfred Hospital. Features examined include cancer detection, clinical findings, diagnostic techniques, histopathological diagnosis of the lesions and surgical management. Results: One hundred and eight cancers were detected in 105 women, with 59% of the cancers impalpable. The benign to malignant ratio was 1.0:1.5. Twenty-four cancers (22%) were ductal carcinoma-in-situ with or without microinvasion, and 84 (78%) were frankly invasive. Of the 86 axillary dissections, 63 (73%) showed no node involvement on histological examination. At the time of diagnosis, 27% of the women had axillary node involvement proven by axillary dissection. The overall mastectomy rate was 58%. Radiotherapy, chemotherapy and tamoxifen were used in both stage I and stage II disease. Conclusion: The surgical management of cancers reflects similar findings reported in other screening programs. There is an increasing trend towards breast conservation surgery and up to 90% of the women in this study present with favourable prognostic factors for long term survival.