title: Surgical caseload and outcomes for women with invasive breast cancer treated in Western Australia.
abstract: We have assessed the outcomes for all women diagnosed with invasive breast cancer in Western Australia during 1989, 1994 and 1999, and compared the results for surgeons who treat 20 or more cases per year with those of surgeons who treat less. Women treated by high caseload surgeons were more likely to retain their breast (53.3% vs. 36.7%, p<0.001), have adjuvant radiotherapy (50.0% vs. 30.6%, p<0.001), and be alive after 4 years (1989, 86% vs. 82%; 1994, 89% vs. 84%; 1999, 90% vs. 79%, HR 0.71, p=0.03). Adjusting for age and year of diagnosis, women were not more likely to be treated with adjuvant chemotherapy (29.2% vs. 20.9%, p=0.28). In 1989 35% of women were treated by high caseload surgeons. By 1999 this had risen to 82%. The results confirm that women treated by high caseload surgeons have better outcomes.
authors.affiliation: Breast Centre, Sir Charles Gairdner Hospital, Western Australia, Australia.
authors.forename: D M
authors.initials: DM
authors.lastname: Ingram
authors.forename: S P
authors.initials: SP
authors.lastname: McEvoy
authors.forename: M J
authors.initials: MJ
authors.lastname: Byrne
authors.forename: L
authors.initials: L
authors.lastname: Fritschi
authors.forename: D J
authors.initials: DJ
authors.lastname: Joseph
authors.forename: K
authors.initials: K
authors.lastname: Jamrozik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011361:Professional Competence; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014904:Western Australia; D016526:Workload