Study finds breast cancer treatments vary from doctor to doctor
January 21, 2011
When faced with breast cancer treatment, there are a number of important decisions that a woman has to make. One of the most important of these, according to a study from the Journal of the National Cancer Institute, is the choice of breast cancer surgeon.
Researchers followed the treatments and outcomes of almost 1,000 women with ductal carcinoma in situ (DCIS) from 1985 through 2000 to see how breast cancer margins (the status of breast tissue surrounding a tumor) and treatments like surgery and radiation affected disease-free survival.
The analysis revealed that the results varied significantly by doctor, largely based on the differing treatments that were chosen. Doctors who performed more breast-conserving surgeries without radiation, for example, had lower rates of cancer-free survival than those who performed mastectomies with radiation.
There's a lot of variability in breast cancer treatment, and treatment choices generally follow discussions between the doctor and patient. Women with breast cancer may want to ask detailed questions about a doctor's experience and preferred approach to treating their type of breast cancer before embarking on a course of therapy.
What to Consider When Choosing a Breast Cancer Surgeon
An editorial accompanying the study suggests, "...it seems that having some sense of whether the provider tolerates positive margins [i.e., remaining cancer cells in tissue surrounding an excised tumor] or not is important, as is some knowledge about whether she or he generally prefers [breast conserving surgery] or mastectomy or recommends [radiation therapy] following [breast conserving surgery]."
In addition, the medical community has to do a better job of providing important information to patients, according to the editorial: "The challenge then is for the professional community to identify factors that are associated with the currently unexplained physician variability and to use that information to promote identification of high-quality providers or quality improvement activities."
Sources: Dick AW et al. "Comparative effectiveness of ductal carcinoma in situ management and the roles of margins and surgeon." Journal of the National Cancer Institute. 2011;103(2):92-104; and Virnig, BA and Tuttle, TM. Editorial: "Random Physician Effect and Comparative Effectiveness of Treatment for Ductal Carcinoma In Situ." Journal of the National Cancer Institute (2011) 103 (2): 81-82. doi: 10.1093/jnci/djq511. First published online: January 3, 2011.
