Breast Ca patients of low-volume surgeons more likely to die, but not from Ca

Breast cancer patients who are treated by high-volume surgeons live longer than breast cancer patients who are treated by low-volume surgeons, but not because they are less likely to die from breast cancer, researchers report in the Oct. 8 issue of the Archives of Internal Medicine.

Ann Butler Nattinger, MD, of the Medical College of Wisconsin in Milwaukee, and colleagues analyzed data on 12,216 women, aged 66 or older, whose stage I or II breast cancers had been operated on by 1,856 surgeons. Cause of death and surgeon volume were determined through death certificate sources and Medicare claims, respectively. Median follow-up was 50 months.

Patients operated on by high-volume surgeons were somewhat less likely to die of causes other than breast cancer (RR 0.86). Patients of high-volume surgeons were slightly younger on average, more likely to be white, more likely to live in more affluent areas, and more likely to be treated at high-volume hospitals. They also had lower levels of comorbidity and had smaller tumors.

"It is possible that the beneficial effect of high-volume surgeons on breast cancer mortality has been overstated," the authors conclude. "Future studies should further evaluate this possibility and rigorously consider whether selection bias could account for volume-outcome relationships for other health concerns."

Nattinger AB, Laud PW, Sparapani RA, et al. Exploring the surgeon volume-outcome relationship among women with breast cancer. Arch Intern Med. 2007;167:1958-1963.