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1 1st February 20:36
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Default Many US surgeons not performing enough breast surgeries (cancer breast cancer)

Professional Development

Many US surgeons not performing enough breast surgeries

Last Updated: 2004-08-11 15:31:41 -0400 (Reuters Health)

By Karla Gale

NEW YORK (Reuters Health) - Patients of surgeons who perform a high
volume of breast cancer surgeries are more likely to receive the
standard of care, such as hormone receptor testing and
breast-conserving surgery, researchers report. But in the U.S, most
breast cancer surgeries are performed by surgeons who do few such
procedures each year.

"Our study looked at how widespread the issue of physicians who are
not performing a lot of breast cancer surgeries might be, and we found
it was disappointingly high," lead author Dr. Joan M. Neuner told
Reuters Health.

Dr. Neuner and her team used a database that linked information from
the Surveillance, Epidemiology, and End Results (SEER) Tumor Registry
with Medicare administrative data to identify patients. They obtained
information about the surgeons from the American Medical Association
Physicians' Professional Data Base.

According to their report in the September 15th issue of Cancer, the
cohort included 8105 Medicare patients with an incident breast cancer
who had surgery performed by one of 987 surgeons between 1994 and

The surgeons operated on a median of six women over the 2-year period
(range 1 to 71), the authors found. Almost half of the patients were
cared for by surgeons who performed no more than 12 operations, and
only 10% by surgeons who performed at least 30.

Because Medicare-age patients comprise 48% of patients with breast
cancer, the authors believe that the average 2-year surgical volumes
they found approximate the 1-year volumes for patients of all ages.
Previous research has shown that physician volume of at least 15 to 30
breast cancer operations annually is associated with higher survival
rates, Dr. Neuner said.

Her group also examined processes of care and found that those
performing the highest volume of surgeries were more likely to perform
lymph node dissection and breast conserving surgery and to order
hormone receptor testing.

"There is some evidence that things like coordinating care well with
other physicians to make sure every single patient gets tamoxifen if
the stage of breast cancer and receptor status requires it, may be as
important or more important than what happens in the operating room,"
Dr. Neuner said.

For generalists who are referring patients for breast cancer surgery,
she advises them to "get to know what the surgeons in your community
are doing. If there is a core group doing a lot more breast surgery,
and you feel you can refer to them more frequently, the data say you
might have better patient outcomes."

Cancer 2004;101.


Copyright 2004 Reuters Ltd.

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