According to the results of a study published is the Archives of Surgery, surgeons who treat a greater number of breast cancer patients are more likely than other surgeons to follow breast cancer treatment recommendations.

Early breast cancer refers to cancer that has not spread from the breast or axillary (under the arm) lymph nodes. Many women with early breast cancer choose to undergo breast-conserving therapy, which includes the removal of the cancer and surrounding tissues and evaluation of axillary lymph nodes, followed by radiation therapy. Alternatively, some women may undergo mastectomy and axillary lymph node evaluation. Women may also receive chemotherapy and/or hormonal therapy.

For several types of cancer, a large and growing body of evidence has demonstrated improved outcomes for patients treated by surgeons who perform a high volume of specialized surgeries and for patients who are treated in a hospital with a high volume of patients undergoing a specific procedure.

To evaluate surgeon characteristics in relation to the type of care provided to women with early breast cancer, researchers evaluated information from a large U.S. cancer registry. Care was classified as consistent with recommendations if it involved breast-conserving surgery with lymph node evaluation and radiation therapy or mastectomy and lymph node evaluation. Surgery that omitted lymph node evaluation and breast-conserving surgery without radiation therapy were considered to be inconsistent with recommendations.

The study involved more than 9,000 women over the age of 65 who had been diagnosed with Stage I or Stage II breast cancer between 1993 and 1996. These women were treated by roughly 1,000 different surgeons.

  • Surgeon age and specialty were not associated with adherence to treatment recommendations.
  • Surgeons who treated a higher number of breast cancer patients were more likely to adhere to treatment recommendations.
  • Female surgeons and surgeons affiliated with a medical school were less likely to adhere to treatment recommendations. These surgeons were more likely to perform breast-conserving surgery without lymph node evaluation. Because the study was not able to collect information about sentinel-node biopsy, however (the study was conducted before it became a standard practice), some of the lymph node evaluations performed by these surgeons may have been missed by the study. Furthermore, there may have been reasons to avoid lymph node evaluation that could not be evaluated by the study.

The researchers conclude that there is variability across surgeons in the type of care provided to early-stage breast cancer patients.

Reference: Gilligan MA, Neuner J, Sparapani R, Laud PW, Nattinger AB. Surgeon characteristics and variations in treatment for early-stage breast cancer. Archives of Surgery. 2007;142:17-22.

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