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Katz SJ , Lantz PM , Janz NK , Fagerlin A , Schwartz K , Liu L , Deapen D , Salem B , Lakhani I , Morrow M
Surgeon perspectives about local therapy for breast carcinoma
Cancer. 2005 ;104(9) :1854-1861
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Abstract
BACKGROUND. Geographic variations in the use of mastectomy and the use of radiation therapy (RT) after breast-conserving surgery (BCS) have motivated concerns that surgeons are not uniformly adhering to treatment standards. METHODS. The authors surveyed attending surgeons of a population-based sample of patients with breast carcinoma diagnosed in Detroit and Los Angeles from December 2001 to January 2003 (n = 365; response rate, 80.0%). Clinical scenarios were used to evaluate opinions about local therapy. RESULTS. On average, surgeons reported that they devoted 31.3% of their total practice to breast carcinoma. Approximately one-half of surgeons practiced in a community hospital setting, whereas 18.8% practiced in a cancer center. Compared to low volume surgeons, high volume surgeons were more likely to favor BCS with RT for invasive breast carcinoma (60.8%, 74.0%, and 87.2% for low, moderate, and high volume surgeons, respectively, P < 0.001). Surgeons who favored BCS were more likely to perceive greater quality of life (QOL) benefits for BCS than mastectomy (85.9%) compared with surgeons who favored mastectomy (28.6%) and those who did not favor 1 procedure over the other (60.0%, P < 0.001). In a ductal carcinoma in situ scenario, 35.0% of surgeons favored BCS without RT and 61.0% favored BCS with RT. Opinions regarding the role of RT after BCS varied by geographic site, surgeon volume, and patient age. CONCLUSIONS. Variation in surgeon opinion concerning local therapy reflected clinical uncertainty about the benefits of alternative treatments. High volume surgeons more frequently endorsed current clinical guidelines that favor BCS compared with mastectomy. This may partly be explained by the greater belief that BCS confers a better patient QOL than mastectomy. © 2005 American Cancer Society.
Notes
0008543X (ISSN) Cited By: 0; Export Date: 25 May 2006; Source: Scopus CODEN: CANCA; DOI: 10.1002/cncr.21396 Language of Original Document: English Correspondence Address: Katz, S.J.; Department of Health Management and Policy; University of Michigan; 300 N. Ingalls Ann Arbor, MI 48109-0429, United States; email: skatz@umich.edu References: Farrow, D.C., Hunt, W.C., Samet, J.M., Geographic variation in the treatment of localized breast cancer (1992) N Engl J Med, 326, pp. 1097-1101; Nattinger, A.B., Gottlieb, M.S., Veum, J., Yahnke, D., Goodwin, J.S., Geographic variation in the use of breast-conserving treatment for breast cancer (1992) N Engl J Med, 326, pp. 1102-1107; Ernster, V.L., Barclay, J., Kerlikowske, K., Grady, D., Henderson, C., Incidence of and treatment for ductal carcinoma in situ of the breast (1996) JAMA, 275, pp. 913-918; Mandelblatt, J.S., Hadley, J., Kerner, J.F., Patterns of breast carcinoma treatment in older women: Patient preferences and clinical and physical influences (2000) Cancer, 89, pp. 561-573; Thompson, T.A., Pusic, A., Kerrigan, C.L., Surgeon perspectives on surgical options for early-stage breast cancer (2000) Plast Reconstr Surg, 105, pp. 910-918; Wennberg, J.E., Unwarranted variations in health care delivery: Implications for academic medical centres (2002) BMJ, 325, pp. 961-964; Kotwall, C., Brinker, C., Covington, D.L., Local and national trends over a decade in the surgical treatment of ductal carcinoma in situ (2003) Am J Surg, 186, pp. 723-728; Baxter, N.N., Virnig, B.A., Durham, S.B., Tuttle, T.M., Trends in the treatment of ductal carcinoma in situ of the breast (2004) J Natl Cancer Inst, 96, pp. 443-448; White, J., Morrow, M., Moughan, J., Compliance wilh breast-conservation standards for patients with early-stage breast carcinoma (2003) Cancer, 97, pp. 893-904; Stafford, D., Szczys, R., Becker, R., Anderson, J., Bushfield, S., How breast cancer treatment decisions are made by women in North Dakota (1998) Am J Surg, 176, pp. 515-519; (1999) Ensuring Quality Cancer Care, p. 97, Hewitt M, Simone JV, editors. National Cancer Policy Board, Institute of Medicine Report and National Research Council. Washington, DC: National Academy Press; Kotwall, C.A., Maxwell, J.G., Covington, D.L., Churchill, P., Smith, S.E., Covan, E.K., Clinicopathologic factors and patient perceptions associated with surgical breast-conserving treatment (1996) Ann Surg Oncol, 3, pp. 169-175; Smitt, M.C., Heltzel, M., Women's use of resources in decision-making for early-stage breast cancer: Results of a community-based survey (1997) Ann Surg Oncol, 4, pp. 564-569; Gemer, L., Breast conservation therapy for breast cancer treatment in Brown County (1999) West Med J, 98, pp. 50-55; Nold, R.J., Beamer, R.L., Helmer, S.D., McBoyle, M.F., Factors influencing a woman's choice to undergo breast-conserving surgery versus modified radical mastectomy (2000) Am J Surg, 180, pp. 413-418; Molenaar, S., Oort, F., Sprangers, M., Predictors of patients' choices for breast-conserving therapy or mastectomy: A prospective study (2004) Br J Cancer, 90, pp. 2123-2130; Morris, J., McNoe, B., Elwood, J.M., Packer, S., Breast cancer surgery in New Zealand: Consensus or variation? (1997) N Z Med J, 110, pp. 53-56; Spyrou, G., Titley, O., Cerqueiro, J., Fatah, M., A survey of general surgeons' attitudes towards breast reconstruction after mastectomy (1998) Ann R Coll Surg Engl, 80, pp. 178-183; Porter, G., McMulkin-Tait, H., Practice patterns in breast cancer surgery: Canadian perspective (2004) World J Surg, 28, pp. 80-86; Mandelblatt, J.S., Berg, C.D., Meropol, N.J., Measuring and predicting surgeons' practice styles for breast cancer treatment in older women (2001) Med Care, 39, pp. 228-242; Katz, S.J., Lantz, P.M., Janz, N.K., The role of patient involvement in surgical treatment decisions for breast cancer (2005) J Clin Oncol, 23, pp. 5526-5533; Dillman, D.A., (1978) Mail and Telephone Surveys, New York: John Wiley and Sons, Inc.; Anema, M.G., Brown, B.E., Increasing survey responses using the total design method (1995) J Contin Educ Nurs, 26, pp. 109-114; Samet, I., Hunt, W., Farrow, D., Determinants of receiving breast-conserving surgery. The Surveillance, Epidemiology, and End Results Program, 1983-1986 (1994) Cancer, 73, pp. 2344-2351; Guadagnoli, E., Weeks, J.C., Shapiro, C.L., Gurwitz, J.H., Borbas, C., Soumerai, S.B., Use of breast-conserving surgery for treatment of stage I and stage II breast cancer (1998) J Clin Oncol, 16, pp. 101-106; Morrow, M., White, J., Moughan, J., Factors predicting the use of breast-conserving therapy in stage I and II breast carcinoma (2001) J Clin Oncol, 19, pp. 2254-2262; Fallowfield, L.J., Hall, A., Maguire, P., Psychological outcomes of different treatment policies in women with early breast cancer outside a clinical trial (1990) BMJ, 301, pp. 575-580; Pozo, C., Carver, C.S., Noriega, V., Effects of mastectomy versus lumpectomy of emotional adjustment to breast cancer: A prospective study of the first year postsurgery (1992) J Clin Oncol, 10, pp. 1292-1298; Nissen, M.J., Swenson, K.K., Ritz, L.J., Farrell, J.B., Sladek, M.L., Lally, R.M., Quality of life after breast carcinoma surgery (2001) Cancer, 91, pp. 1238-1246; Janz, N.K., Mujahid, M., Lantz, P.M., Population-based study of the relationship of treatment and sociodemographics on quality of life after breast cancer (2005) Qual Life Res, 14, pp. 1467-1479; Weinberg, E., Woods, S., Grannan, K., Hendy, M.P., The influence of gender of the surgeon on surgical procedure preference for breast cancer (2002) Am Surg, 68, pp. 398-400; Arriagada, R., Le, M.G., Rochard, F., Contesso, G., Conservative treatment versus mastectomy in early breast cancer: Patterns of failure with 15 years of follow-up data (1996) J Clin Oncol, 14, pp. 1558-1564, Institute Gustave-Roussy Breast Cancer Group; Veronesi, U., Cascinelli, N., Mariani, L., Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer (2002) N Engl J Med, 347, pp. 1227-1232; Fisher, B., Anderson, S., Bryant, J., Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy and lumpectomy plus irradiation for the treatment of invasive breast cancer (2002) N Engl J Med, 347, pp. 1233-1241; Poggi, M.M., Danforth, D.N., Sciuto, L.C., Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy. The National Cancer Institute Randomized Trial (2003) Cancer, 98, pp. 697-702; Van Dongen, J.A., Voogd, A.C., Fentiman, I.S., Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial (2000) J Natl Cancer Inst, 92, pp. 1143-1150; Blichert-Toft, M., Rose, C., Andersen, J.A., Danish randomized trial comparing breast conservation therapy with mastectomy: Six years of life-table analysis (1992) J Natl Cancer Inst Monogr, 11, pp. 19-25, Danish breast cancer cooperative group; Frykberg, E.R., Bland, K.I., In situ breast carcinoma (1993) Adv Surg, 26, pp. 29-72; Bijker, N., Peterse, J.L., Duchateau, L., Risk factors for recurrence and metastasis after breast-conserving therapy for ductal carcinoma-in-situ: Analysis of European Organization for Research and Treatment of Cancer trial 10853 (2001) J Clin Oncol, 19, pp. 2263-2271; Fisher, B., Land, S., Mamounas, E., Dignam, J., Fisher, E.R., Wolmark, N., Prevention of invasive breast cancer in women with ductal carcinoma in situ: An update of the National Surgical Adjuvant Breast and Bowel Project Experience (2001) Semin Oncol, 28, pp. 400-418; Lagios, M.D., Silverstein, M.J., Ductal carcinoma in situ. The success of breast conservation therapy: A shared experience of two single institutional nonrandomized prospective studies (1997) Surg Oncol Clin North Am, 6, pp. 385-392; Silverstein, M.J., Ductal carcinoma in situ of the breast: Controversial issues (1998) Oncologist, 3, pp. 94-103; Silverstein, M.J., Fortnightly review: Ductal carcinoma in situ of the breast (1998) BMJ, 317, pp. 734-739; Morrow, M., Bucci, C., Rademaker, A., Medical contraindications are not a major factor in the underutilization of breast conserving surgery (1998) J Am Coll Surg, 186, pp. 269-274.