Treatment at High-volume Hospital Linked with Better Breast Cancer Survival
According to the results of a study published in the American Journal of Public Health, women with early-stage breast cancer have better survival if they undergo surgery at a hospital that performs a large number of breast cancer surgeries.
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 explore the link between hospital volume and breast cancer survival, researchers conducted a study among more than 11,000 Medicare beneficiaries who underwent surgery for Stage I or Stage II breast cancer. These surgeries were performed at 457 different hospitals in the U.S.
Hospital volume was defined as the number of breast cancer surgeries performed on Medicare beneficiaries each year. Low volume was defined as 0 to 19 cases per year, medium volume was defined as 20 to 39 cases per year, and high volume was defined as 40 or more cases per year.
On average, study participants were followed for roughly five years after surgery.
- Compared to women treated at a low-volume hospital, women treated at a high-volume hospital were 17% less likely to die of any cause and 20% less likely to die of breast cancer.
- Surgery at a high-volume hospital was linked with better survival among women with lymph node-negative cancer as well as among women with lymph node-positive cancer.
The researchers conclude that treatment at a hospital that performs a greater number of breast cancer surgeries appears to result in better survival among women undergoing surgery for breast cancer.
Reference: Gilligan MA, Neuner J, Zhang X, Sparapani R, Laud PW, Nattinger AB. Relationship between number of breast cancer operations performed and 5-year survival after treatment for early-stage breast cancer. American Journal of Public Health. 2007;97:539-544.
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