Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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

Caprice C Greenberg  1 , Stuart R Lipsitz, Melissa E Hughes, Stephen B Edge, Richard Theriault, John L Wilson, W Bradford Carter, Douglas W Blayney, Joyce Niland, Jane C Weeks
Affiliations

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

Caprice C Greenberg et al. Ann Surg. 2011 Aug.

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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
The rates of breast conserving surgery, mastectomy alone, or mastectomy with reconstruction across NCCN centers. (N = 10,607, χ2, P < 0.0001)
See this image and copyright information in PMC

References

    1. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347(16):1233–1241. - PubMed
    1. Fisher B, Bauer M, Margolese R, et al. Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med. 1985;312(11):665–673. - PubMed
    1. Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347(16):1227–1232. - PubMed
    1. Veronesi U, Saccozzi R, Del Vecchio M, et al. Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast. N Engl J Med. 1981;305(1):6–11. - PubMed
    1. Christian CK, Gustafson ML, Roth EM, et al. A prospective study of patient safety in the operating room. Surg. 2006;139(2):159–173. - PubMed

Publication types

MeSH terms