title: Breast cancer: do specialists make a difference?
abstract: BACKGROUND
  Many believe that breast cancer should be treated by specialists. We studied the effect of surgeon and hospital specialization on survival after breast cancer treatment in a large, well-defined patient population.
  
  
  METHODS
  The Cancer Surveillance Program database for Los Angeles County was reviewed. Between 1990 and 1998, 43,411 cases of breast cancer were diagnosed, of which 29,666 had complete data on surgeon, hospital, and staging information. Patients were stratified on the basis of surgeon and hospital specialization, as well as by age, race, stage, surgical procedure, and surgeon and hospital case volume. An analysis of survival and its dependence on these factors was performed.
  
  
  RESULTS
  Age, race, socioeconomic status, tumor size, nodal status, extent of disease, surgeon specialization, surgeon case volume, and hospital case volume were all associated with 5-year survival after diagnosis of breast cancer. Treatment at a specialty center did not affect survival. Multivariate analysis indicated that type of surgeon was an independent predictor of survival (relative risk,.77), as were both hospital and surgeon case volume.
  
  
  CONCLUSIONS
  Treatment by a surgical oncologist resulted in a 33% reduction in the risk of death at 5 years. The effect of surgical specialization cannot be entirely attributed to volume effects.
authors.affiliation: Department of Surgery, Norris Comprehensive Cancer Center, University of Southern California/Keck School of Medicine, Los Angeles, California, USA. kristin.skinner@med.nyu.edu
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Skinner
authors.forename: James T
authors.initials: JT
authors.lastname: Helsper
authors.forename: Dennis
authors.initials: D
authors.lastname: Deapen
authors.forename: Wei
authors.initials: W
authors.lastname: Ye
authors.forename: Richard
authors.initials: R
authors.lastname: Sposto
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D002140:California; D002173:Cancer Care Facilities; D016208:Databases, Factual; D005260:Female; D013502:General Surgery / Q000592:standards*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008495:Medical Oncology / Q000592:standards*; D008511:Medicine; D008875:Middle Aged; D009367:Neoplasm Staging; D011159:Population Surveillance; D011379:Prognosis; D044469:Racial Groups; D012923:Social Class; D013038:Specialization; D016019:Survival Analysis; D016896:Treatment Outcome