Provider case volume and outcome in the evaluation and treatment of patients with mammogram‐detected breast carcinoma

Abstract

BACKGROUND Practice volume may affect the outcome of patients with breast carcinoma. Defining factors that influence the relation of volume and outcome for the diagnosis and treatment of breast carcinoma is important, because breast carcinoma is common, and care is decentralized. METHODS Community‐wide diagnosis and treatment of mammogram‐detected breast carcinoma was examined using claims data from a single insurer representing 25% of the regional population. Among 1001 mammogram‐directed breast biopsies, the rate of breast carcinoma diagnosed by stereotactic core needle biopsy (SCNB) or excisional biopsy with needle localization (EBNL) and the rate at which breast‐conserving surgery (BCS) was used were analyzed. Outcome and practice volume were examined for surgeons, radiologists, and medical centers. RESULTS Two hundred twenty‐four tumors were diagnosed by EBNL (604 diagnoses) and SCNB (397 tumors), for a 22.4% positive biopsy rate. The median number of procedures per physician was one. Positive biopsy rates for radiologists, surgeons, and medical centers did not correlate with practice volume. Positive biopsy rates for high‐volume physician providers and medical centers ranged from 9% to 46%. The BCS rate was 45% and 64% for surgeons treating one or more than one claim, respectively. Tumor stage and surgeon case volume were the only independent predictors of BCS (P < 0.05). CONCLUSIONS There is wide variation in diagnosis and treatment outcomes for patients with mammogram‐detected breast carcinoma. Overall, practice volume was correlated with the use of BCS but not with the rate of positive biopsy. A wide variation in the positive biopsy rate among high‐volume providers and medical centers suggests that volume of practice is not a surrogate for quality in the diagnosis of breast carcinoma. Cancer 2002;95:704–12. © 2002 American Cancer Society. DOI 10.1002/cncr.10737

Provider’s volume and quality of breast cancer detection and treatment

“…More than two thirds of the papers reviewed assessed the likelihood of receiving conservative or definitive surgery [29, 32-39, 41-43, 45-52, 54, 55, 59, 63, 65]. Virtually all studies listed in Table 2 took account of the characteristics of patients [10, 29-39, 41-51, 53-61, 63-65], half considered characteristics of hospitals other than volume [10, 33-39, 41-44, 46, 51, 52, 55, 56, 61, 63, 64], but only a minority adjusted for the caseload [10,29,42,50,54,56,57,61] or some other characteristics of the attending physician [10,34,35,37,38,42,43,47,56,61,65]. Treatment was taken into account as adjustment variable in a few papers [10,29,44,48,53,57,58].…”

“…In all of them, the surgeon was the focus of investigation. The study by McKee et al [50] also looked at the rate of positive mammogram-directed breast biopsies according to the number of procedures performed by the radiologist. Two publications [76,84] were based on self-reported survey data about either the rate of immediate breast reconstruction following mastectomy in Canada [76] or the use of breast conservative surgery by Iranian surgeons [84].…”

“…We identified 29 studies [29,42,50,54,56,57,59,61,, including three updates [57,81,86], on the association between the physician's caseload and the process or outcomes of therapeutic interventions for breast cancer. In all of them, the surgeon was the focus of investigation.…”

“…Caseloads of both the attending physician and hospital of treatment have been investigated for their association with the process or outcomes of treatment. Studies on hospital volume are summarized in Table 2 [10, and those on the caseload of the attending physician in Table 3 [29,42,50,54,56,57,59,61,.…”

Zertifizierte multidisziplinäre Brustzentren

“…Die Mastektomierate im Vergleich zur brusterhaltenden Therapierate war in kleineren Zentren höher, obwohl es dabei in der Tumorgröße keine Unterschiede gab und in den kleineren Abteilungen sogar eher T1-Tumoren vorkamen als in den Zentren. McKee [25] und Kotwall [21] führten dies u. a. darauf zurück, dass es keine interdisziplinäre Zusammenarbeit mit der Möglichkeit der Bestrahlung vor Ort gab.…”