Breast Cancer News:

Many Surgeons Do Not Perform Enough Breast Cancer Surgeries for Best Results

Many U.S. surgeons do not perform sufficient numbers of breast cancer surgeries to obtain optimum results, according to a study reported in the August 9 online edition of the journal Cancer.

Breast cancer is one of the most common cancers in the United States and the second leading cause of death in women. Virtually all treatment options require surgery. Earlier studies have shown that patients have higher survival rates five years after undergoing surgery by a physician performing at least 15 to 30 breast cancer operations a year.

Wisconsin Medical College researchers reviewed data reported by 989 surgeons on 8,105 surgeries they performed on Medicare patients 65 years and older from 1994 to 1995. Half of the surgeons performed six or fewer breast cancer surgeries, while 79 performed 12 or less in two years. Twenty-eight percent of surgeons performed no breast cancer operations on Medicare patients in each year of the study.

“We were surprised to find that despite sufficient evidence associating low surgical volumes and lack of experience with poor outcomes, the majority of breast cancer surgeries in women are done by surgeons who do not specialize in cancer or breast cancer surgery,” said study author Joan M. Neuner, M.D., assistant professor of general internal medicine.

Patients of physicians with the higher volumes were more likely to receive surgical care more consistent with standard of care, such as hormone receptor testing, breast conserving surgery and lymph node dissection.

Although the majority of surgeons were board-certified general surgeons, 25 percent were not board-certified or were general surgeons with surgical subspecialty training. Less than one percent of surgeons identified themselves as oncologic surgeons with subspecialty training. The few surgical oncologists and the other board-certified surgeons had higher volumes of cases compared with both general surgeons without board certification and nonsurgeons.

“The next step is to determine the key steps these high-volume surgeons are using to obtain better results and see if their practice can be used by the larger community of surgeons,” said Neuner.

Source: Medical Week staff, week of August 9, 2004