Many U.S. surgeons are not doing adequate numbers of operations for primary breast cancer to optimize patient survival

Aug 9 2004

A new study finds many U.S. surgeons are not doing adequate numbers of operations for primary breast cancer to optimize patient survival.

The study, published August 9, 2004 in the online edition of CANCER, a peer-reviewed journal of the American Cancer Society, demonstrates that fewer surgeries per year negatively impacted patient standard of care. A free abstract of the study is available at CANCER Online.

Breast cancer is one of the most common cancers in the U.S. and nearly all patients have surgery. Several recent studies have shown that patients who receive their primary surgery from surgeons with a lower volume of breast cancer patients have a worse prognosis. In the U.S., surgeons who performed 15 or more breast cancer surgeries per year had a significant reduction in five-year mortality rates. In the U.K., surgeons who performed 30 or more breast cancer surgeries per year also reported a significant reduction in five-year mortality rates.

To characterize the patient volume of U.S. surgeons and its relationship to care, Joan M. Neuner M.D., M.P.H., and her colleagues from the Medical College of Wisconsin reviewed 989 surgeons reporting clinical data to the Surveillance, Epidemiology and End Results (SEER) –Medicare linked tumor registry over a two year period. As nearly half of U.S. breast cancer patients are aged 65 or older when breast cancer develops, the 2-year surgical volumes for Medicare patients on average approximate 1-year volumes for patients of all ages.

The authors found that fewer than 20 percent of surgeons had the volume of cases (>15) associated with lower mortality in U.S. studies, and only 2 percent performed the volume of operations found to be associated with lower breast cancer mortality in the U.K. (>30). The median surgeon performed only 6 operations on Medicare patients in two years. Twenty-eight percent of surgeons performed no breast cancer operations on Medicare patients in each year of the study.

Significantly, patients of physicians with the highest patient 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.

“Despite the growing evidence that low surgical volumes are associated with worse outcomes in many types of cancer care, our study shows that U.S. breast cancer surgeons on average perform surprisingly few annual operations for primary breast cancer,” conclude the authors.

Article: “Decentralization of Breast Cancer Surgery in the United States,” Joan M. Neuner, Mary Ann Gilligan, Rodney Sparapani, Purushottam W. Laud, David Haggstrom, Ann B. Nattinger, CANCER; Published Online: August 9, 2004 (DOI: 10.1002/cncr.20490); Print Issue Date: September 15, 2004.