This article explores the change in use of breast-conserving surgery in patients with stage I or II breast cancer in western Washington. The premise of the study is that the 1990 National Institutes of Health (NIH)-sponsored Consensus Development Conference may have changed the policies of surgeons during a period from January 1, 1983, to December 31, 1993. The Conference recommended breast-conserving surgery as the preferred treatment over mastectomy for women with stage I or II disease.
This study1 underscores a number of interesting patterns in the United States. Foremost is the underuse of breast-conserving surgery despite multiple studies demonstrating equivalent survival to mastectomy and despite the recommendations from the NIH Consensus Development Conference that breast-conserving surgery be used because of improved psychological outcome and no difference in survival. Even the present report, which shows increased use of breast-conserving surgery in the western Washington area, reported only a rate of