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Are Women Seeing the Most Experienced Breast Cancer Surgeons?

Women who took more control over choosing their breast cancer surgeon were more likely to be treated by more experienced // breast surgeons and at a hospital affiliated with an accredited cancer program, compared to women who were referred by another doctor or their health plan, according to a study led by researchers at the University of Michigan Comprehensive Cancer Center.

The study looked at 1,844 women recently diagnosed with breast cancer in the Detroit and Los Angeles metropolitan areas. Information was collected from the Surveillance, Epidemiology and End Results Registry, a database maintained by the National Cancer Institute that collects information about cancer incidence, treatment and mortality. Results of the study appear in the Jan. 20 issue of the Journal of Clinical Oncology.

The women were surveyed about how the breast surgeon was selected, with choices such as “I was referred by another doctor,” “I chose this surgeon because of his or her reputation” or “I wanted a surgeon who practiced near my home.” Based on the answers, patients were categorized as being referred to their surgeon or selecting their surgeon based on reputation or proximity.

Nearly two-thirds of the patients said they were referred to their surgeon by another doctor, with another 15 percent referred by their health plan. About a quarter chose their surgeon based on reputation. Women with more education and higher incomes were more likely to report selecting their surgeon based on reputation.

About one-third of the women were treated by a high-volume surgeon – a surgeon who devoted more than half of his or her practice to breast surgery. Also, two-thirds of the women were treated in a hospital with a cancer program approved by the American College of Surgeons or a National Cancer Institute-designated cancer center.

Women who selected their surgeon based on reputation were more likely to be treated by a high-volume surgeo n and more likely to be treated at an NCI or American College of Surgeons-approved cancer center, the researchers found. Women who said their doctor or health plan referred them to a surgeon were less likely to be treated at an NCI-designated cancer center.

“Women with breast cancer should be aware that referrals from another doctor or their health plan may not connect them with the most experienced surgeons or the most comprehensive practice settings in their community. Patients might consider seeking a second opinion, especially if they are advised to undergo a particular treatment without a full discussion of the options,” says study author Steven Katz, M.D., MPH, professor of internal medicine at the U-M Medical School and director of Health Services Research at the U-M Comprehensive Cancer Center. Katz is also professor of health management and policy at the U-M School of Public Health.

"Katz and colleagues have performed a valuable service by identification of the importance of structure, which they define in terms of the individual providers linked to patients and the volume associated with those providers," Katherine Kahn, M.D., professor of internal medicine at UCLA Medical Center, says in an accompanying editorial.

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