title: Geographic variation in sentinel node adaptation by practicing surgeons in Oregon.
abstract: BACKGROUND
  The sentinel node biopsy (SNB) technique is an important tool in the diagnosis and treatment of breast cancer and melanoma. However, surgeons in Oregon have not universally adopted its use.
  
  
  METHODS
  Mailed questionnaire.
  
  
  RESULTS
  The response rate was 32%. Seventy-four (76%) of the surgical respondents perform routine SNB; 49% completed courses, and 32% learned the technique in residency. Sixty-one (89%) performed axillary dissection with their initial cases. It took 21 of 40 (52%) surgeons greater than a year to accrue 20 cases. Of 23 surgeons (24%) not performing SNB, 89% believed it was an important skill to obtain, and 70% thought they would benefit from proctoring opportunities. Six (26%) did not have technological support at their hospital. Surgeons at hospitals with less than 50 beds (P = .001) and at rural hospitals (P = .003) were less likely to perform SNB.
  
  
  CONCLUSIONS
  The majority of urban general surgeons in Oregon use SNB in their practice. However, the incorporation of SNB for surgeons practicing in smaller hospitals and rural settings is less frequent than in the urban environment. As SNB becomes the standard of care, we need to overcome these barriers so that patients can have access to this procedure in their own communities.
authors.affiliation: Department of Surgery, Oregon Health & Science University, Portland, OR, USA. garreauj@ohsu.edu
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Garreau
authors.forename: Joanne
authors.initials: J
authors.lastname: Nelson
authors.forename: David
authors.initials: D
authors.lastname: Cook
authors.forename: John
authors.initials: J
authors.lastname: Vetto
authors.forename: Deb
authors.initials: D
authors.lastname: Walts
authors.forename: Louis
authors.initials: L
authors.lastname: Homer
authors.forename: Nathalie
authors.initials: N
authors.lastname: Johnson
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D002983:Clinical Competence; D005843:Geography; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology*; D008545:Melanoma / Q000473:pathology* / Q000601:surgery; D009922:Oregon; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D021701:Sentinel Lymph Node Biopsy; D011795:Surveys and Questionnaires