Évaluation des pratiques de prise en charge initiale du cancer du sein de petite taille chez la femme

Abstract

To improve management of patients with breast cancer by providing healthcare professionals with a discussion tool based on an assessment of their local practices compared with national guidelines.Retrospective survey assessing the medical files of all patients who had surgery for ductal carcinoma of the breast (maximum diameter<2 cm) in any Strasbourg hospital during the second quarter of 2002. Cases were identified from the central medical database (PMSI). Procedures were compared with national guidelines and results discussed with the healthcare professionals involved.In all, 154 women were referred to 19 surgeons at 8 hospitals (public: 3; private: 5) between April 1 and June 30, 2002. The number of procedures per surgeon during this period ranged from 1 to 33. Surgery occurred within the recommended time from radiologic diagnosis (i.e.<4 weeks) in only 26% of cases. There was no preoperative diagnostic staging for 14%, and no preliminary discussion at multidisciplinary team meetings for 36%. In 36% of standard axillary lymph node dissections, fewer than 10 lymph nodes were cleared. Intraoperative radiography was not mentioned for 42% of subjects with microcalcifications. The pTNM status was not reported in 44% of histology reports from 15 experienced pathologists, surgical margins were not documented in 13%, and information on vascular invasion was missing from 54%. Finally, 30% of patients received lower doses of radiation therapy than recommended.Important differences between hospitals showed the need for improvement of several processes. Better coordination between surgeons and pathologists is essential. The results of this survey point out the value of external evaluation processes to sensitize professionals and improve the overall management of patients with breast cancer.