Surgeon perspectives about local therapy for breast carcinoma.

Geographic variations in the use of mastectomy and the use of radiation therapy (RT) after breast-conserving surgery (BCS) have motivated concerns that surgeons are not uniformly adhering to treatment standards. The authors surveyed attending surgeons of a population-based sample of patients with breast carcinoma diagnosed in Detroit and Los Angeles from December 2001 to January 2003 (n = 365; response rate, 80.0%). Clinical scenarios were used to evaluate opinions about local therapy. On average, surgeons reported that they devoted 31.3% of their total practice to breast carcinoma. Approximately one-half of surgeons practiced in a community hospital setting, whereas 18.8% practiced in a cancer center. Compared to low volume surgeons, high volume surgeons were more likely to favor BCS with RT for invasive breast carcinoma (60.8%, 74.0%, and 87.2% for low, moderate, and high volume surgeons, respectively, P < 0.001). Surgeons who favored BCS were more likely to perceive greater quality of life (QOL) benefits for BCS than mastectomy (85.9%) compared with surgeons who favored mastectomy (28.6%) and those who did not favor 1 procedure over the other (60.0%, P < 0.001). In a ductal carcinoma in situ scenario, 35.0% of surgeons favored BCS without RT and 61.0% favored BCS with RT. Opinions regarding the role of RT after BCS varied by geographic site, surgeon volume, and patient age. Variation in surgeon opinion concerning local therapy reflected clinical uncertainty about the benefits of alternative treatments. High volume surgeons more frequently endorsed current clinical guidelines that favor BCS compared with mastectomy. This may partly be explained by the greater belief that BCS confers a better patient QOL than mastectomy.

Katz SJ ，Lantz PM ，Janz NK ，Fagerlin A ，Schwartz K ，Liu L ，Deapen D ，Salem B ，Lakhani I ，Morrow M ... -  《CANCER》

Conflicts in decision-making for breast cancer surgery.

Opatt D ，Morrow M ，Hawley S ，Schwartz K ，Janz NK ，Katz SJ ... -  《ANNALS OF SURGICAL ONCOLOGY》

Correlates of referral practices of general surgeons to plastic surgeons for mastectomy reconstruction.

General surgeons' attitudes toward breast reconstruction may affect referrals to plastic surgeons. The propensity to refer to plastic surgeons prior to surgical treatment decisions for breast cancer varies markedly across general surgeons and is associated with receipt of reconstruction. In this study, the authors used data from a large physician survey to examine factors associated with general surgeons' propensity to refer breast cancer patients to plastic surgeons prior to mastectomy. The authors surveyed all attending general surgeons (N=456 surgeons) from a population-based sample of breast cancer patients who were diagnosed in Detroit and Los Angeles during 2002 (N=1844 patients), with a surgeon response rate of 80%. The dependent variable was surgeon report of the percentage of their mastectomy patients in the past 2 years who they referred to plastic surgeons prior to initial surgery (referral propensity). Referral propensity was collapsed into 3 categories (<25%, 25-75%, and >75%) and regressed on the following covariates using logistic regression: Surveillance, Epidemiology, and End Results registry; number of years in clinical practice; surgeons' sex; annual breast surgery volume; and hospital setting. Only 24% of surgeons referred>75% of their patients to plastic surgeons prior to surgery (high referral propensity). High referral propensity was associated independently with surgeons who were women (odds ratio [OR], 2.3; P=.03), high clinical breast surgery volume (OR, 4.1; P<.01), and working in cancer centers (OR, 2.4; P=.01). High-referral surgeons and low-referral surgeons also had different beliefs about women's preferences for reconstruction, with the low-referral surgeons perceiving more access barriers (cost, availability of plastic surgeons) and a lower patient priority for reconstruction. A large proportion of surgeons do not refer breast cancer patients to plastic surgery at the time of surgical decision-making. Surgeons who have a high referral propensity are more likely to be women, to have a high clinical breast volume, and to work in cancer centers. These data support the importance of comanagement through multidisciplinary care models. Women need more opportunities to discuss reconstructive options to make informed surgical treatment decisions about their breast cancer.

Alderman AK ，Hawley ST ，Waljee J ，Morrow M ，Katz SJ ... -  《CANCER》

Correlates of between-surgeon variation in breast cancer treatments.

Hawley ST ，Hofer TP ，Janz NK ，Fagerlin A ，Schwartz K ，Liu L ，Deapen D ，Morrow M ，Katz SJ ... -  《MEDICAL CARE》

The use of radiation therapy after breast-conserving surgery in hormonally treated breast cancer patients is dependent on patient age, geographic region, and surgeon specialty.

Chagpar AB ，McMasters KM ，Scoggins CR ，Martin RC 2nd ，Thoene C ，Edwards MJ ... -  《-》