Oncology is a difficult enough specialty to practise at the best of times; it has now become even more challenging as a result of the article by Ruhee Chaudhry and colleagues.1 I can't believe this type of research was published, let alone placed as the lead article in CMAJ.
The teaching centre cases tended to have more favourable characteristics (smaller tumours, more favourable tumour grades and greater proportions of estrogen-receptor-positive tumours) than the community hospital cases. It should be noted that in fact more women were treated with adjuvant systemic therapy in the community hospitals than in the teaching hospitals (38% v. 30%). It is distressing that the authors draw conclusions with such far-reaching clinical implications from this study.
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Brian P. Higgins
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]