Shortage of Seasoned Breast Cancer Surgeons Seen

Study: Medicare patients not getting experienced specialists

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By
HealthDay Reporter

TUESDAY, Aug. 10, 2004 (HealthDayNews) -- In the wake of research suggesting that experienced surgeons are more likely to successfully remove breast tumors, a new study finds that seasoned breast cancer surgeons might be few and far between.

While researchers in the United States and Great Britain have found that breast cancer patients live longer if their surgeons perform more than 15 or 30 operations a year, the average American surgeon surveyed only performed a median of six procedures over two years in older women on Medicare.

While the new study isn't extensive enough to directly link rookie surgeons to higher death rates among patients, the numbers do show the importance of finding experienced doctors, said study author Dr. Joan Neuner, an assistant professor of medicine at the Medical College of Wisconsin in Milwaukee. "Talk to your doctor about how many breast cancer surgeries they do in a year, how much experience they have with what you're having done," she said.

Breast cancer is the second leading cause of death among women in the United States, and surgery is required in almost all cases.

Neuner and her colleagues began exploring the experience levels of breast cancer surgeons after reviewing two previous studies. One, in Great Britain, found that female breast cancer patients were more likely to survive for five years if their surgeons performed 30 or more operations a year. The second study, in Los Angeles County, linked better five-year survival rates to surgeries performed by doctors who did 15 or more such operations a year.

Similar links have been found between surgeon experience and better survival rates of patients with esophageal and pancreatic cancer, Neuner said. But those are extremely deadly forms of cancer that often kill patients near the time of surgery, while most breast cancer patients "do fine" immediately after their operations, she said.

The researchers, all from the from the Medical College of Wisconsin, reviewed statistics compiled in 1994 and 1995 from 989 U.S. cancer surgeons who operated on 8,105 Medicare patients aged 65 or older. Since about half of all breast cancer patients are over 65, the researchers assumed the total number of patients treated by the surgeons over one year would be equal to the number of older patients treated over two years.

The findings appear in the Aug. 9 issue of Cancer.

Seventy-nine percent performed a dozen or fewer operations on Medicare patients in two years; 28 percent of the surgeons performed no breast cancer operations in each year of the study.

Why are so many surgeons inexperienced in breast cancer procedures? It may be because the surgeons perform a variety of other operations, especially in rural areas, Neuner said.

The study didn't examine whether some of the surgeons specialize in younger patients, who may have better insurance, especially in upscale urban areas. Neuner said future research will explore how the ages of patients and their socioeconomic levels affect breast cancer care, although she added that national statistics are more complete when it comes to older patients.

More research is also needed to better understand the habits of highly experienced surgeons, she said. There are some clues in the new study, however: Experienced physicians were more likely to provide specialized testing, lymph node dissection, and breast-conserving surgery.

Wendy Mason, manager of the national HelpLine at the Susan G. Komen National Breast Cancer Foundation in Dallas, suggests that women with breast cancer explore their medical options.

"Helping women understand what quality care is is absolutely crucial," she said. "A lot of women are diagnosed and they're scared, they're anxious. They go to the first surgeon their doctor recommends, and they assume that person is well-qualified."

More information

Learn about breast cancer treatments from the Susan G. Komen National Breast Cancer Foundation.

SOURCES: Joan Neuner, M.D., M.P.H. assistant professor, medicine, Medical College of Wisconsin, Milwaukee; Wendy Mason, manager, national HelpLine, Susan G. Komen National Breast Cancer Foundation, Dallas; Aug. 9, 2004, Cancer

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