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Ann Surg. 2011 Aug;254(2):339-45. doi: 10.1097/SLA.0b013e3182263bb0.

Institutional variation in the surgical treatment of breast cancer: a study of the NCCN.

Author information

  • 1Center for Outcomes and Policy Research, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. ccgreenberg@partners.org

Abstract

OBJECTIVE:

To investigate the relationship between supply of subspecialty care and type of procedure preferentially performed for early stage breast cancer.

BACKGROUND:

Three surgical options exist for early stage breast cancer: (1) breast conserving surgery (BCS), (2) mastectomy with reconstruction (RECON), and (3) mastectomy alone. Current guidelines recommend that surgical treatment decisions should be based on patient preference if a patient is eligible for all 3. However, studies demonstrate persistent variation in the use of BCS and RECON.

METHODS:

Patients undergoing an operation for DCIS or stage I or II breast cancer at NCCN institutions between 2000 and 2006 were identified. Institutional procedure rates were determined. Spearman correlations measured the association between procedure types. Patient-level logistic regression models investigated predictors of procedure type and association with institutional supply of subspecialty care.

RESULTS:

Among 10,607 patients, 19% had mastectomy alone, 60% BCS, and 21% RECON. The institutional rate of BCS and RECON were strongly correlated (r = -0.80, P = 0.02). Institution was more important than all patient factors except age in predicting receipt of RECON or BCS. RECON was more likely for patients treated at an institution with a greater supply of reconstructive surgeons or where patients live further from radiation facilities. RECON was less likely at institutions with longer waiting times for surgery with reconstruction.

CONCLUSIONS:

Even within the NCCN, a consortium of multidisciplinary cancer centers, the use of BCS and mastectomy with reconstruction substantially varies by institution and correlates with the supply of subspecialty care.

PMID:
21725233
[PubMed - indexed for MEDLINE]
PMCID:
PMC3428030
Free PMC Article

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