Breast cancer pathology practices among Medicare patients undergoing unilateral extended simple mastectomy.
OBJECTIVE
Information in pathology reports of breast cancer specimens is of critical importance to treating physicians for selection of local regional treatment and adjuvant therapy, evaluation of therapy, estimation of prognosis, and analysis of outcomes. This information is also of great importance to patients and their families. The Cancer Committee of the College of American Pathologists (CAP) and the Association of Directors of Anatomic and Surgical Pathology (ADASP) have published protocols for reporting the findings on breast cancer specimens to encourage adequate specimen examination and promote the reporting of findings in standardized formats and to provide treating physicians and their patients with vital information.


METHODS
To assess the quality of breast cancer pathology practices and the degree to which they agree with published guidelines, we undertook a retrospective analysis among Medicare patients in New York State. Our random sample consisted of 748 (43.5%) of the 1718 cases of unilateral extended simple mastectomy, also referred to as total mastectomy with lymph node dissection (ICD-9-CM procedure code 85.43), for calendar year 1999. Of these, 555 (74.2%) were available for study, whereas the rest did not satisfy inclusion criteria. Among the 555 cases, 545 (98.2%) were women, and 10 (1.8%) were men. The gender distribution was proportionately the same at 98.2% and 1.8% for all 1718 cases.


RESULTS
We examined the 555 hospital records for 16 elements (quality indicators). Aggregate performance on 7 of these was > or =83.7%, and performance was < or = 69.4% on 9 others. There were significant interhospital disparities in performance levels for a number of quality indicators. Although some hospitals always recorded certain indicators, others never did.


CONCLUSIONS
The issues with breast cancer pathology reports identified in this study are amenable to improvement to better serve patients, especially women, and their treating physicians in making adjuvant decisions, estimating prognosis, and evaluating outcomes.
Imperato
Pascal James
PJ
IPRO, Lake Success, New York 11042, USA.
Waisman
Jerry
J
Wallen
Marcia
M
Llewellyn
Christine C
CC
Pryor
Veronica
V
D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D018567:Breast Neoplasms, Male / Q000473:pathology / Q000601:surgery; D005260:Female; D005568:Forms and Records Control / Q000592:standards; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008408:Mastectomy / Q000379:methods; D008499:Medical Records / Q000592:standards*; D006278:Medicare; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D010337:Pathology Department, Hospital / Q000592:standards*; D010340:Pathology, Surgical / Q000592:standards*; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D014481:United States