Research Pays In Breast Cancer Care

Women who choose their own surgeon and hospital get better breast cancer care than those who rely on doctor or health plan referrals, a new survey suggests.

Most doctors who perform breast cancer operations are general surgeons who see many kinds of patients. But studies suggest women who need breast cancer surgery have better outcomes if they see surgeons highly experienced in the kind of surgery they need.

In their study, Steven Katz, M.D, M.P.H., and colleagues surveyed 1,844 women diagnosed with breast cancer. Katz is director of health services research at the University of Michigan Comprehensive Cancer Center. The researchers found that only a third of the women were treated by a high-volume surgeon — one with more than 50 percent of his practice devoted to breast cancer surgery. Two-thirds of the women were treated in hospitals designated as cancer centers by the National Cancer Institute or the American College of Surgeons.

Women who said they chose their own surgeon were twice as likely to see a highly experienced surgeon as were those referred by another doctor or by their health plan.

"Women who were more actively involved in selecting their surgeon were more likely to be treated by surgeons more experienced in breast surgery and in more comprehensive treatment settings," Katz and colleagues report. "By contrast, the provider-based referral pathway was not associated with surgeon volume" in breast cancer surgeries.

They advise women to get a second opinion — especially if their doctor recommends a specific procedure without a full discussion of the options.

Katz and colleagues report their findings in the Jan. 20 issue of the Journal of Clinical Oncology.

SOURCES: Katz, S. Journal of Clinical Oncology, Jan. 20, 2007; manuscript received ahead of publication. News release, University of Michigan.

By Daniel DeNoon
Reviewed by Louise Chang, M.D