Canadian breast cancer practice guidelines were meant to reduce variation in how the disease is treated but that is not how it has worked out, a new study from Manitoba suggests.

Rates of surgical procedures hadn't changed between 1995 and 2003, even though the Canadian Practice Guidelines for the Care and Treatment of Breast Cancer were published in 1998, the researchers concluded.

"Our results suggest that the Canadian breast cancer guidelines are not meeting their stated objective," the study's authors wrote in Tuesday's issue of the Canadian Medical Association Journal. "New strategies for guideline dissemination and implementation may be required."

To see how the guidelines affected practice, Dr. Steven Latosinsky of the surgery department at the University of Manitoba looked at 7,022 women in Manitoba who were diagnosed with breast cancer from 1995 to 2003.

For the study, the team applied four measures of care for Manitoba's population-based cancer registry, which collects data on the stage of cancer.

The researchers tested for differences in provincewide rates and variations among surgeons before and after the guidelines were released.

Effective as possible

In related journal commentary, Dr. Eva Grunfeld of Cancer Care Nova Scotia in Halifax, looked at whether the guidelines are effective.

Publishing the guidelines is only the first step in getting doctors to put them into practice, Grunfeld said. The guidelines are a means to an end and not an end in themselves.

"One can conclude that Canada's breast cancer guidelines are as effective as possible, under the circumstances," Grunfeld wrote.