Abstract
Background: Several studies have demonstrated a relatively low rate of breast conservation surgery (BCS) in the United States. Few have analyzed the impact of individual surgeon variability on the outcome of the procedure, and none have contrasted surgical oncologists versus general surgeons in the treatment of nonpalpable breast cancer.
Methods: A blinded review was done of 409 excisions for nonpalpable breast cancer performed by 11 board-certified general surgeons (GS, n=221) and one surgical oncologist (SO, n=185) in a teaching institution. We compared surgical margins, need for reexcision, and breast conservation rates.
Results: Although there were no significant differences in patient and tumor characteristics, there were surprising differences between the GS and SO, especially related to surgical margins and final treatment. The SO has a significantly higher rate of frozen section compared to GS (81% vs. 64%,P<0.01) and a lower rate of positive margin at the time of original biopsy (25% vs. 41%,P<0.01). These differences translated into lower necessity for reexcision of tumor (18% vs. 48%,P<0.01) and higher rate of BCS (88% vs. 70%,P<0.01).
Conclusion: This study demonstrates marked differences among trained general surgeons. The additional experience of a surgical oncologist is valuable, because fewer positive margins lead to a higher likelihood of breast preservation and decreased costs related to fewer additional operative procedures.
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References
Tabar L, Faberberg CJG, Gad A, et al. Reduction in mortality from breast cancer after mass screening with mammography: a randomized trial from the Breast Cancer Screening and Working Group of the Swedish National Board of health and Welfare.Lancet 1985;1:829–32.
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;312:665–73.
NIH Consensus Conference. Treatment of early-staged breast cancer.JAMA 1991;265:391–5.
Osteen RT, Steele GD Jr., Menck HR, Winchester DP. Regional differences in surgical management of breast cancer.CA Cancer J Clin 1992;42:39–43.
Kotwell CA, Covington DL, Rutledge R, Churchill MP, Meyer AA. Patient, hospital and surgeon factors associated with breast conservation surgery.Ann Surg 1996;224:419–29.
Mann BA, Samet JM, Hunt WC, Key CR, Goodwin JM, Goodwin JS. Changing treatment of breast cancer in New Mexico from 1969 through 1985.JAMA 1988;259:3413–7.
Lazovich D, White E, Thomas D, Moe RE. Underutilization of breast-conserving surgery and radiation therapy among women with Stage I or II breast cancer.JAMA 1991;266:3433–8.
Kopans DB, Lindfors KK, McCarthy KA, Meyer JE. Spring hook wire breast lesion localizer. Use with rigid-compression mammographic systems.Radiology 1985;157:537–8.
Gould FW, Robinson PG. The pathologists' examination of the “lumpectomy”—the pathologists' view of surgical margins.Semin Surg Oncol 1992;8:129–35.
Taftra L, Guenther JM, Giuliano AE. Planned segmentectomy. A necessity for breast carcinoma.Arch Surg 1993;128:1014–8.
Alexander HR, Candela FC, Dershaw D, Kinne DW. Needle-localized mammographic lesions.Arch Surg 1990;125:1441–4.
Nguyen HN, Averette HE, Hoskins W, Penalver M, Sevin B, Sterin A. National Survey of ovarian cancer. Part V: The impact of physician's specialty on patients' survival.Cancer 1993;72:3663–7.
Rosen L, Stasik JJJ, Olenwine JA, Aronoff JS, Sherman D. Variations in colon and rectal surgery mortality: Comparison of specialties with a state-legislated database.Dis Colon Rectum 1996;39:129–35.
McArdle CS, Hole D. Impact of variability among surgeons on postoperative morbidity and mortality and ultimate survival.Br Med J 1991;302:1501–5.
Burn I. Surgical oncology specialisation.World Federation of Surgical Oncology Societies Newsletter 1997;5:3.
McFarlane JK. Whither surgical oncology?Can J Surg 1994;37:445.
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Blair, S.L., O'Shea, K.E. & Orr, R.K. Surgeon variability in treating nonpalpable breast cancer: Surgical oncology as a value-added specialty. Annals of Surgical Oncology 5, 28–32 (1998). https://doi.org/10.1007/BF02303760
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DOI: https://doi.org/10.1007/BF02303760