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Health Serv Res. 1990 December; 25(5): 809–823.
PMCID: PMC1065665

Changing practice patterns in the management of primary breast cancer: Consensus Development Program.


In the last decade, new knowledge has emerged concerning the efficacy of treatment for breast cancer. For that reason, the National Institutes of Health devoted a consensus conference to this topic. To determine whether the consensus conference had influenced practice patterns, and to evaluate the level of quality of care given to women with breast cancer, the medical records of 573 patients treated in ten hospitals throughout the state of Washington were abstracted and analyzed. Results showed no changes with respect to the consensus conference's recommendations for use of a total mastectomy with axillary dissection or the use of a two-step procedure in which the biopsy is performed first and therapeutic options are discussed before a definitive surgery is undertaken. Analyses of quality of care issues not addressed by the consensus conference revealed that 4 percent of the sample were explicitly staged preoperatively and 29 percent postoperatively and that little changed over time in the use of sentinel laboratory tests. These results also show that consensus recommendations will not necessarily change physicians' behavior even where change is possible, and that quality of care in diagnosis and treatment of breast cancer still needs to be addressed.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Fisher B. Sounding board. Breast-cancer management: alternatives to radical mastectomy. N Engl J Med. 1979 Aug 9;301(6):326–328. [PubMed]
  • Greenfield S, Blanco DM, Elashoff RM, Ganz PA. Patterns of care related to age of breast cancer patients. JAMA. 1987 May 22;257(20):2766–2770. [PubMed]
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  • Kosecoff J, Kanouse DE, Rogers WH, McCloskey L, Winslow CM, Brook RH. Effects of the National Institutes of Health Consensus Development Program on physician practice. JAMA. 1987 Nov 20;258(19):2708–2713. [PubMed]
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  • Moxley JH, 3rd, Allegra JC, Henney J, Muggia F. Treatment of primary breast cancer. Summary of the National Institutes of Health Consensus Development Conference. JAMA. 1980 Aug 22;244(8):797–800. [PubMed]
  • Polissar L, Finley ML. Time trends and key factors in the choice of one-step or two-step biopsy and surgery for breast cancer. Soc Sci Med. 1985;21(7):733–740. [PubMed]
  • Urban JA. Treatment of primary breast cancer. Management of local disease: minority report. JAMA. 1980 Aug 22;244(8):800–803. [PubMed]
  • Winkler JD, Kanouse DE, Brodsley L, Brook RH. Popular press coverage of eight National Institutes of Health consensus development topics. JAMA. 1986 Mar 14;255(10):1323–1327. [PubMed]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust