Breast cancer care linked with surgeon factors

Last Updated: 2008-01-29 16:01:37 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Surgeon characteristics, such as gender or country of training, appear to influence whether a women with breast cancer receives radiotherapy after surgery to remove the cancer, also referred to as adjuvant radiotherapy, according to a report in the Journal of the National Cancer Institute.

Because adjuvant radiotherapy lowers the risk of cancer recurrence, the U.S. Agency for Healthcare Research and Quality considers radiotherapy after breast conservation surgery a quality of care indicator; yet many do not receive this treatment, Dr. Dawn L. Hershman and colleagues, from Columbia University in New York, point out.

The goal of their study was to determine whether surgeon-related factors play a role in whether or not a woman with breast cancer undergoes radiotherapy after breast conservation surgery.

The researchers analyzed data from 29,760 women, age 65 years or older, who underwent breast conservation surgery for early-stage (I/II) breast cancer between 1991 and 2002. The patients' information was entered in the Surveillance, Epidemiology, and End-Results-Medicare linked database. The surgeons' characteristics were assessed using information in the American Medical Association Masterfile.

Overall, 75 percent of the women received adjuvant radiotherapy, the report indicates. Women who had radiotherapy tended to be younger, have fewer other illnesses and more likely to be white, married and from an urban area. They were also more likely to be diagnosed with breast cancer later in the time period analyzed than women who were not treated with radiotherapy.

The surgeons of patients who underwent radiotherapy were more likely to be women than men, (79 percent vs. 73 percent), to have an MD rather than DO degree (75 percent vs. 68 percent), and to have trained in the U.S. rather than elsewhere (75 percent vs. 70 percent). Women who had surgeons who treated more patients also were more likely to receive radiotherapy.

"Our study is one of the first to demonstrate associations between certain surgeon characteristics and quality of breast cancer care," Hershman and colleagues conclude.

If these findings are confirmed, research will be needed on whether these patterns reflect the surgeons' behavior, the patients' response, or physician-patient interactions.

SOURCE: Journal of the National Cancer Institute, February 6, 2008.