Breast cancer is a disease that is notoriously heterogeneous. Virtually every week a new factor is identified to help predict which patients will have a superior chance of survival. Ruhee Chaudhry and colleagues provide another: whether the surgery is performed at a teaching or nonteaching institution.1 Although this is an interesting factor to consider, their study is potentially damaging to community hospitals, particularly when the majority of breast cancer surgeries in Ontario are performed in nonteaching hospitals.
Tumour grading was not done in almost half of the cases in the community hospitals, whereas estrogen receptor status was not known in 21% of the teaching hospital cases. These differences in tumour characteristics, along with differences in Her-2/neu oncogene status, would likely account for the differences in survival outcomes. The factors the authors suggested to try to explain the differences, including the use of multidisciplinary teams, closer follow-up and improved supportive care, are important in management, but they have never been shown to make any difference to survival.
Signature
Robert E. Myers
Medical oncologist Credit Valley Hospital Mississauga, Ont.
Reference
- 1.Chaudhry R, Goel V, Sawka C. Breast cancer survival by teaching status of the initial treating hospital. CMAJ 2001;164(2):183-8. [PMC free article] [PubMed]