Surgeon Characteristics and Use of Breast Conservation Surgery in Women With Early Stage Breast Cancer

Abstract

Background Most women with localized breast cancer (BC) have a choice between mastectomy and breast conserving surgery (BCS). Aside from clinical factors, this decision may be associated with surgeon and patient characteristics. We investigated the effect of surgeon characteristics on the BCS rate. Methods We used the SEER-Medicare database to identify women >65 years, diagnosed with stages I-II BC, between 1991–2002, and used the Physician Unique Identification Number linked to the American Medical Association Masterfile to obtain information on surgeons. We investigated the association of patient demographic, tumor, and surgeon-related factors with receipt of BCS, using Generalized Estimating Equations to control for clustering. Results Of 56,768 women with BC, 30,006 (53%) underwent BCS while 26,762 (47%) underwent mastectomy. From 1991 to 2002, the proportion of patients undergoing BCS increased from 35% to 60%. In a multivariate analysis, patients who received BCS were younger, of higher SES, and had more favorable tumor characteristics. They were also more likely to be black and live in metropolitan areas. Women who underwent BCS were more likely to have surgeons who were female (OR=1.40; 95%CI 1.25–1.55), US-trained (OR=1.12; 95%CI 1.02–1.22), with a larger patient panel (OR=1.29; 95%CI 1.21–1.39), and completed training after 1975 (OR=1.16; 95%CI 1.08–1.25), than surgeons of patients who underwent mastectomy. Conclusions Surgeon characteristics, such as gender, training, year of graduation and volume, are small but significant independent predictor of BCS. Efforts to differentiate whether these associations reflect patients’ preferences, quality of physician training, surgeon attitudes, physician-patient communication, or other effects on decision-making are warranted.

A Review of the Effectiveness of Breast Surgical Oncology Fellowship Programs Utilizing Kirkpatrick’s Evaluation Model

“…Higher-volume surgeons were also much more likely to correctly perceive that the quality of life at 1 year is higher for women who receive BCS than for women who received a mastectomy (47.2 % for low-volume surgeons vs 65.4 % for high-volume surgeons; Wald test=27.5; P<0.001) [9]. Similar results have been found by others and demonstrate the ability of specialists to appreciate the multidisciplinary impact that a mastectomy has on women [10][11][12][13][14].…”

Survival in stage I–III breast cancer patients by surgical treatment in a publicly funded health care system

“…Surgeon and hospital factors may also play a role. Surgeon preferences, surgeon and hospital volume and hospital teaching status have been found to be associated with type of surgery and may also be associated with survival [22][23][24]. Further investigation into these factors is merited, as results may have potential for policy implications.…”

Uptake of Oxaliplatin and Bevacizumab for Treatment of Node-Positive and Metastatic Colon Cancer

“…Higher surgeon case load has repeatedly been associated with improved surgical outcomes. 28,29 Subspecialty surgical training was also associated with surgical outcomes in one study. 30 In the current study, we found a consistent association between provider volume and use of newer chemotherapy drugs.…”