Could General Surgeons With Special Interest in Breast Surgery Deliver a Quality Service Despite a Paradigm Shift Towards Specialisation? An Indepth Analysis of Quality Assessment-Based Practice at a General Surgeon-Led Breast Unit in the United Kingdom

Abstract

Background: Despite specialisation, a small subset of general surgeons continues to provide breast services in the United Kingdom. We aimed to assess breast cancer i) local recurrence rate against the national benchmarks of <5% (for invasive cancer) and <10% (for noninvasive cancer) at 5- year, and ii) net survival rates against national record of 95.8% and 85.3%, at 1-year and 5-year, respectively. Methods: All breast cancers (between 01/05/2012 and 30/04/2013) at a district general hospital in the north-west of England were audited. Two general surgeons provided the breast service. One surgeon performed mostly excisional surgery and acted as a 'generalist'. The second surgeon also performed level 2 oncoplastic procedures and acted as an internal control as a 'specialist'. Results: Out of 270 cancers diagnosed, 203 patients underwent surgery. Six patients (out of 180 invasive cancers) developed local recurrences (3.33%). Two patients (out of 23 patients with Ductal Carcinoma-In-Situ) developed local recurrences (8.69%). There was no signicant intersurgeon variation in practice except a difference in the size of the excised lesions. 1-year and 5-year net survival rates amongst all female breast cancer patients were 97% and 87.3%, respectively. Overall survival at 5-year was 79.1%. Conclusions: The results demonstrate that in an unselected cohort of breast cancer patients, general surgeons with interest in breast surgery can achieve acceptable standards in terms of local recurrence at 5-year, and net survivals at 1-year and 5-year. No conceivable difference in practice between two surgeons with 'generalist' and 'specialist' skill-mix was noted. Low overall survival might reect wider health issues. This has implications in planning a local breast service and utilising constrained human resources in the era of specialisation.