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Breast Cancer: Do Specialists Make a Difference?

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Abstract

Background: Many believe that breast cancer should be treated by specialists. We studied the effect of surgeon and hospital specialization on survival after breast cancer treatment in a large, well-defined patient population.

Methods: The Cancer Surveillance Program database for Los Angeles County was reviewed. Between 1990 and 1998, 43,411 cases of breast cancer were diagnosed, of which 29,666 had complete data on surgeon, hospital, and staging information. Patients were stratified on the basis of surgeon and hospital specialization, as well as by age, race, stage, surgical procedure, and surgeon and hospital case volume. An analysis of survival and its dependence on these factors was performed.

Results: Age, race, socioeconomic status, tumor size, nodal status, extent of disease, surgeon specialization, surgeon case volume, and hospital case volume were all associated with 5-year survival after diagnosis of breast cancer. Treatment at a specialty center did not affect survival. Multivariate analysis indicated that type of surgeon was an independent predictor of survival (relative risk, .77), as were both hospital and surgeon case volume.

Conclusions: Treatment by a surgical oncologist resulted in a 33% reduction in the risk of death at 5 years. The effect of surgical specialization cannot be entirely attributed to volume effects.

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REFERENCES

  1. Choti MA, Bowman HM, Pitt HA, et al. Should hepatic resections be performed at high-volume referral centers? J Gastrointest Surg 1998; 2:11–20.

    Article  PubMed  CAS  Google Scholar 

  2. Begg CB, Cramer LD, Hoskins WJ, Brennan MF. Impact of hospital volume on operative mortality for major cancer surgery. JAMA 1998; 280:1747–51.

    Article  PubMed  CAS  Google Scholar 

  3. Glasgow RE, Showstack JA, Katz PP, Corvera CU, Warren RS, Mulvihill SJ. The relationship between hospital volume and outcomes of hepatic resection for hepatocellular carcinoma. Arch Surg 1999; 134:30–5.

    Article  PubMed  CAS  Google Scholar 

  4. Birkmeyer J, Siewers AE, Finlayson EV, et al. Hospital volume and surgical mortality in the United States. N Engl J Med 2002; 346:1128–37.

    Article  PubMed  Google Scholar 

  5. Rosemurgy A, Bloomston M, Serafini FM, Coon B, Murr MM, Carey LC. Frequency with which surgeons undertake pancreaticoduodenectomy determines length of stay, hospital charges, and in-hospital mortality. J Gastrointest Surg 2001; 5:21–6.

    Article  PubMed  CAS  Google Scholar 

  6. Simunovic M, To T, Theriault M, Langer B. Relation between hospital surgical volume and outcome for pancreatic resection for neoplasm in a publicly funded health care system. CMAJ 1999; 160:643–8.

    PubMed  CAS  Google Scholar 

  7. Sosa J, Bowman HM, Gordon TA, et al. Importance of hospital volume in the overall management of pancreatic cancer. Ann Surg 1998; 228:429–38.

    Article  PubMed  CAS  Google Scholar 

  8. Glasgow R, Mulvihill S. Hospital volume influences outcome in patients undergoing pancreatic resection for cancer. West J Med 1996; 165:294–300.

    PubMed  CAS  Google Scholar 

  9. Lieberman M, Kilburn H, Lindsey M, Brennan MF. Relation of perioperative deaths to hospital volume among patients undergoing pancreatic resection for malignancy. Ann Surg 1995; 222:638–45.

    Article  PubMed  CAS  Google Scholar 

  10. Dudley R, Johansen KL, Brand R, Rennie DJ, Milstein A. Selective referral to high-volume hospitals: estimating potentially avoidable deaths. JAMA 2000; 283:1159–66.

    Article  PubMed  CAS  Google Scholar 

  11. Saettler E, Temple W. The surgeon as a prognostic factor in the management of pancreatic cancer. Surg Oncol Clin North Am 2000; 9:133–42.

    CAS  Google Scholar 

  12. Bach P, Cramer LD, Schrag D, Downey RJ, Gelfand SE, Begg CB. The influence of hospital volume on survival after resection for lung cancer. N Engl J Med 2001; 345:181–8.

    Article  PubMed  CAS  Google Scholar 

  13. Hillner B. Is cancer care best at high-volume providers? Curr Oncol Rep 2001; 3:404–9.

    Article  PubMed  CAS  Google Scholar 

  14. Schrag D, Cramer LD, Bach PB, Cohen AM, Warren JL, Begg CB. Influence of hospital procedure volume on outcomes following surgery for colon cancer. JAMA 2000; 284:3028–35.

    Article  PubMed  CAS  Google Scholar 

  15. Simons A, Ker R, Groshen S, et al. Variations in treatment of rectal cancer: the influence of hospital type and caseload. Dis Colon Rectum 1997; 40:641–6.

    Article  PubMed  CAS  Google Scholar 

  16. Marusch F, Koch A, Schmidt U, Pross M, Gastinger I, Lippert H. Hospital caseload and the results achieved in patients with rectal cancer. Br J Surg 2001; 88:1397–402.

    Article  PubMed  CAS  Google Scholar 

  17. Ellison L, Heaney J, Birkmeyer J. The effect of hospital volume on mortality and resource use after radical prostatectomy. J Urol 2000; 163:867–9.

    Article  PubMed  CAS  Google Scholar 

  18. Yao S-L, Lu-Yoa G. Population-based study of relationships between hospital volume of prostatectomies, patient outcomes, and length of hospital stay. J Natl Cancer Inst 1999; 91:1950–6.

    Article  PubMed  CAS  Google Scholar 

  19. Lerut T. The surgeon as a prognostic factor. Ann Surg 2000; 232:729–32.

    Article  PubMed  CAS  Google Scholar 

  20. Roohan P, Bickell NA, Baptiste MS, Therriault GD, Ferrara EP, Siu AL. Hospital volume differences and five-year survival from breast cancer. Am J Public Health 1998; 88:454–7.

    Article  PubMed  CAS  Google Scholar 

  21. SSO Mission Statement. 2002. Society of Surgical Oncology Web site. Available at: http://www.surgonc.org/sso/missframe.htm. Accessed May 13, 2003.

  22. Kalbfleisch J, Prentice R. The Statistical Analysis of Failure Time Data. New York: Wiley, 1980.

    Google Scholar 

  23. Dixon WJ, Massey FJ. Introduction to Statistical Analysis. 3rd ed. New York: McGraw-Hill, 1969.

    Google Scholar 

  24. Bickell N, Chassin M. Determining the quality of breast cancer care. Do tumor registries measure up? Ann Intern Med 2000; 132:705–10.

    PubMed  CAS  Google Scholar 

  25. Birkmeyer J, Warshaw AL, Finlayson SR, Grove MR, Tosteson AN. Relationship between hospital volume and late survival after pancreaticoduodenectomy. Surgery 1999; 126:178–83.

    PubMed  CAS  Google Scholar 

  26. Morrow M, Stewart A, Sylvestar J, Bland K. Hospital volume predicts outcomes in breast cancer: a National Cancer Data Base (NCDB) study (abstract). Proc Am Soc Clin Oncol 2000; 19:309.

    Google Scholar 

  27. Latosinsky S, Bear H. Do surgical oncologists achieve lower rates of loco-regional recurrence in node positive breast cancer treated with mastectomy alone? J Surg Oncol 2001; 78:2–7.

    Article  PubMed  CAS  Google Scholar 

  28. Giacomantonio C, Temple W. Quality of cancer surgery. Challenges and controversies. Surg Oncol Clin North Am 2000; 9:51–60.

    CAS  Google Scholar 

  29. Gillis C, Hole D. Survival outcome of care by specialist surgeons in breast cancer. A study of 3786 patients in the west of Scotland. BMJ 1996; 312:145–8.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Norris Comprehensive Cancer Center, University of Southern California/Keck School of Medicine, Los Angeles, California

    Kristin A. Skinner MD & James T. Helsper MD

  2. Department of Surgery Preventive Medicine, Norris Comprehensive Cancer Center, University of Southern California/Keck School of Medicine, Los Angeles, California

    Dennis Deapen PhD, Wei Ye MS & Richard Sposto PhD

  3. NYU School of Medicine, Department of Surgery, 550 First Avenue, HCC 6H, New York, NY, 10016-6481

    Kristin A. Skinner MD

Authors
  1. Kristin A. Skinner MD
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  2. James T. Helsper MD
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  3. Dennis Deapen PhD
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  4. Wei Ye MS
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  5. Richard Sposto PhD
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Correspondence to Kristin A. Skinner MD.

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Skinner, K.A., Helsper, J.T., Deapen, D. et al. Breast Cancer: Do Specialists Make a Difference?. Ann Surg Oncol 10, 606–615 (2003). https://doi.org/10.1245/ASO.2003.06.017

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  • DOI: https://doi.org/10.1245/ASO.2003.06.017

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