Abstract
OBJECTIVE--To compare survival outcome for patients with breast cancer cared for by specialist and non-specialist surgeons in a geographically defined area. DESIGN--Retrospective study of all female patients aged under 75 years in the area treated between 1980 and June 1988 (before breast screening began). Patients were identified from the cancer registry and from pathology records of all hospitals in the area. Specialist surgeons were identified by one author. All other surgeons caring for patients from the area were considered non-specialists. SETTING--A geographically defined population in urban west of Scotland. SUBJECTS--3786 patients with histologically verified breast cancer operated on between 1 January 1980 and 30 June 1988 and followed to 31 December 1993. MAIN OUTCOME MEASURES--Five and 10 year survival rates for specialists and non-specialists; relative hazard ratios derived from Cox's proportional hazards model adjusted for prognostic factors--age, socioeconomic status, tumour size, and nodal involvement. RESULTS--The five year survival rate was 9% higher and the 10 year survival 8% higher for patients cared for by specialist surgeons. A reduction in risk of dying of 16% (95% confidence interval 6% to 25%) was found after adjustment for age, tumour size, socioeconomic status, and nodal involvement. The benefit of specialist care was apparent for all age groups, for small and large tumours, and for tumours that did and did not affect the nodes and was consistent across all socioeconomic categories. CONCLUSIONS--Survival differences of the magnitude demonstrated have implications for the provision of services for the treatment of women with breast cancer. There is a need to improve equity in the treatment of breast cancer.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- BLOOM H. J., RICHARDSON W. W. Histological grading and prognosis in breast cancer; a study of 1409 cases of which 359 have been followed for 15 years. Br J Cancer. 1957 Sep;11(3):359–377. doi: 10.1038/bjc.1957.43. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Basnett I., Gill M., Tobias J. S. Variations in breast cancer management between a teaching and a non-teaching district. Eur J Cancer. 1992;28A(12):1945–1950. doi: 10.1016/0959-8049(92)90233-r. [DOI] [PubMed] [Google Scholar]
- Carnon A. G., Ssemwogerere A., Lamont D. W., Hole D. J., Mallon E. A., George W. D., Gillis G. R. Relation between socioeconomic deprivation and pathological prognostic factors in women with breast cancer. BMJ. 1994 Oct 22;309(6961):1054–1057. doi: 10.1136/bmj.309.6961.1054. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Carter C. L., Allen C., Henson D. E. Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases. Cancer. 1989 Jan 1;63(1):181–187. doi: 10.1002/1097-0142(19890101)63:1<181::aid-cncr2820630129>3.0.co;2-h. [DOI] [PubMed] [Google Scholar]
- Harding M. J., Paul J., Gillis C. R., Kaye S. B. Management of malignant teratoma: does referral to a specialist unit matter? Lancet. 1993 Apr 17;341(8851):999–1002. doi: 10.1016/0140-6736(93)91082-w. [DOI] [PubMed] [Google Scholar]
- Junor E. J., Hole D. J., Gillis C. R. Management of ovarian cancer: referral to a multidisciplinary team matters. Br J Cancer. 1994 Aug;70(2):363–370. doi: 10.1038/bjc.1994.307. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Karjalainen S. Geographical variation in cancer patient survival in Finland: chance, confounding, or effect of treatment? J Epidemiol Community Health. 1990 Sep;44(3):210–214. doi: 10.1136/jech.44.3.210. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Olivotto I. A., Bajdik C. D., Plenderleith I. H., Coppin C. M., Gelmon K. A., Jackson S. M., Ragaz J., Wilson K. S., Worth A. Adjuvant systemic therapy and survival after breast cancer. N Engl J Med. 1994 Mar 24;330(12):805–810. doi: 10.1056/NEJM199403243301201. [DOI] [PubMed] [Google Scholar]
- Sainsbury R., Haward B., Rider L., Johnston C., Round C. Influence of clinician workload and patterns of treatment on survival from breast cancer. Lancet. 1995 May 20;345(8960):1265–1270. doi: 10.1016/s0140-6736(95)90924-9. [DOI] [PubMed] [Google Scholar]