Breast Cancer: Do Specialists Make a Difference?

Abstract

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.

Survival from breast cancer: an analysis of Australian data by surgeon case load, treatment centre location, and health insurance status

“…53 The association between higher surgeon case load and higher survival found both in the unadjusted analysis and the analysis adjusted for age and clinical risk factors, accords with results of most studies in North America, Europe, Asia and Western Australia. 16,[28][29][30][31][32][33][34][35][36][37][38][39][40] The difference mostly occurred between 21-100 cases per annum and lower case loads, with little difference observed between the 21-100 and higher case loads. Other studies have shown a progressive association between higher case loads and survival, interpreted by some researchers as strengthening evidence of a causal relationship.…”

“…This was similar to classifications in some other studies, although classification categories have not been consistent across studies. [28][29][30][31][32][33][34][35][36][37][38][39][40][41] Treatment centre location was categorised as major city, inner regional or more remote, using the Australian Standard Geographical Classification. 44 These categories are based on Census Collection Districts (CDs) categorised using the Accessibility/Remoteness Index for Australia (ARIA), which is a measure of the remoteness of a location from the services provided by large towns or cities.…”

“…16,[19][20][21][22][23][24][25][26][27] Often these were studies of other cancers, although higher survivals from breast cancer have been linked to higher case loads in North America, Europe, Asia and Western Australia. [28][29][30][31][32][33][34][35][36][37][38][39][40] Results have generally been interpreted as reflecting higher skill development from managing higher case loads, although this interpretation has been questioned and alternative explanations suggested, including accompanying differences in degree of specialisation, access to multidisciplinary conferencing, and availability of specialist adjunctive services. 22,33,41 In the USA, lack of private health insurance can be a barrier to appropriate breast and other cancer care for optimising survival.…”

390 Breast Cancer Management and Outcome According to Surgeon's Affiliation – A Population-based Comparison Adjusted for Patient's Selection Bias

“…a non-specialist surgeon resulted in a 33% reduction in the risk of death at 5 years in multivariate analysis, while treatment at a specialist center did not affect survival [15]. A significant increase in survival was also observed in a population-based cohort of 2192 patients in Oklahoma city for patients operated by specialist surgeons versus non-specialists.…”

Fylkesvise forskjeller i overlevelse av brystkreft

“…Andre studier har vist sammenheng mellom kirurgvolum og dødelighet ved avanserte kirurgiske inngrep (21,22). Dette kan også vaere tilfelle for kirurgisk behandling av brystkreft (23)(24)(25)(26)(27). Man diskuterer om den økte overlevelsen kan forklares gjennom bedret kirurgi eller om det er den enkelte brystkreftkirurgen som i større grad henviser til høyspesialiserte brystonkologer (28,29).…”