Changes in stage and treatment of breast cancer in Florence from 1985–1990

All incident breast cancers in the city of Florence during 1985, 1986 and 1990 were reviewed and staged according to the TNM-UICC classification. The type of surgical intervention was assessed and the probability of having had a radical mastectomy estimated by logistic regression. 715 breast cancer cases were incident during 1985, 1986 and 1990 in the city of Florence. The proportion of Tis + T 1 cancers was 44% in 1985, 46% in 1986 and 55% in 1990. The proportion of patients undergoing conservation changed from 22% in 1985 to 47% in 1986 and 52% in 1990 respectively. An estimate of the probability of having a radical mastectomy, adjusting for size and nodal status, showed age and surgery department as strong predictors. Estimates of the fraction of radical treatment attributable to either the attitude of the surgeon and to patient age is calculated as accounting for 51% of the total number of patients having radical mastectomy. There has been little change in the stage of presentation of breast cancer but there have been major changes in treatment during the 6 years of this review. Although there has been a move towards breast conservation for small lesions, there is a wide variation between individual surgeons in the numbers of patients with small operable breast cancers who are treated by breast conserving surgery.