Impact of experience in breast cancer surgery on survival: the role of quality of care in a registry-based cohort

Abstract

AIMS OF THE STUDY: Previous studies have suggested that the surgeon's experience in breast cancer surgery may affect patient survival. In this registry-based retrospective cohort study, we examined whether quality of care could partly explain this association. METHODS: All invasive breast cancers operated on in the private sector between 2000 and 2009 were identified in the Geneva Cancer Registry and followed up for 5 years. Surgeons were classified according to their experience into three categories: ≤5, 6-10, >10 breast cancer operations performed per year. We extracted patient and tumour characteristics. Quality of care was scored as the proportion of 11 quality indicators correctly fulfilled for each patient. Breast cancer-specific mortality was examined with a Cox model adjusted for variables known to affect survival, surgeon experience, and quality of care. RESULTS: A total of 1489 patients were operated on by 88 surgeons; 50 patients (3.4%) died from breast cancer during the 5 years of follow-up. Socioeconomic status and country of birth of the patients, as well as period of diagnosis, differed according to the surgeons' experience. Quality of care provided improved with surgeon's experience. Surgeons performing >10 operations/year more frequently assessed histology before surgery, excised sentinel lymph nodes, removed ≥10 lymph nodes, and prescribed adjuvant radiotherapy when indicated. Crude breast cancerspecific mortality was lower in patients treated by surgeons performing >10 compared with ≤5 operations/year (hazard ratio [HR] 0.34, 95% confidence interval [CI] 0.17-0.67; p = 0.002). The strength of the association decreased after adjustment for patient and tumour characteristics (HR 0.45, 95% CI 0.21-0.94; p = 0.034) and decreased further after adjustment for quality of care (HR 0.51, 95% CI 0.24-1.08, p = 0.078). CONCLUSIONS:The association between surgeon's experience and 5-year breast cancer survival is at least part-ly explained by quality of care, patient and tumour characteristics. Further investigations on the impact of other quality indicators such as multidisciplinary networks are needed.

Breast cancer and occupation: Non-parametric and parametric net survival analyses among Swiss women (1990–2014)

“…While tumor stage and age at diagnosis are two major prognostics factors, other factors including tumor characteristics, treatment, comorbidities, and socioeconomic status have been suggested to impact the BC survival ( 8 , 10 ). Yet, neither socioeconomic differences in stage at diagnosis nor other sociodemographic factors such as age, nationality and marital status could explain the survival inequalities observed in Switzerland ( 11 ).…”

Mapping of Female Breast Cancer Incidence and Mortality Rates to Socioeconomic Factors Cohort: Path Diagram Analysis

“…Today, cancers have brought a huge threat to human health. Human beings have made considerable progress in dealing with breast cancer, such as disease prevention (21), cancer screening (22), etiological analysis (23), targeted drugs (24,25), and clinical surgery (26). Despite important advances in the understanding of oncogenesis and development in the past decades, breast cancer remains one of the most common cancers diagnosed among women and the leading cause of female cancer death (27).…”

Mapping of female breast cancer incidence and mortality rates to socioeconomic factors cohort: Path diagram analysis

“…Todays, cancers have brought a huge threat to human health. Human beings have made considerable progress in dealing with breast cancer, such as disease prevention [21], cancer screening [22], etiological analysis [23], targeted drugs [24,25] and clinical surgery [26]. Despite important advances in the understanding of oncogenesis and development in the past decades, breast cancer remains one of the most common cancers diagnosed among women and the leading cause of female cancer death [27].…”