Physician practice volume and alternative surgical treatment for breast cancer in Florida.
OBJECTIVE
To determine whether surgeon procedure volume is related to the selection of a surgical option (mastectomy versus breast-conserving surgery) for breast cancer treatment . STUDY SETTING/STUDY DESIGN: Secondary data sources were used to study surgical procedures performed for female breast cancer in Florida during the years 1997-98 in a retrospective population-based analysis.


METHODS
Surgical procedures for female breast cancer in Florida were identified during 1997 and 1998 (N = 28,380) by combining data from the Florida Acute Hospital and Short-term Psychiatric Inpatient Data Collection and the Ambulatory Outpatient Data Collection. A total of 1,320 physicians who provided breast surgical procedures in Florida during the two-year study period were identified.


RESULTS
After controlling for selected patient and physician characteristics, the lowest volume surgeons were nearly twice as likely to perform mastectomies rather th an breast-conserving surgery compared with the highest volume group. Patients with Medicaid as an insurer were also nearly twice as likely to receive mastectomies. Patient demographic factors such as age, while statistically significant, were shown to be far less predictive of procedure choice. Forty-two percent of the physicians performed fewer than two surgeries on average per year.


CONCLUSIONS
Patients treated by lower volume physicians have a greater likelihood of receiving mastectomies than do those patients treated by higher volume physicians.
Luther
S L
SL
Center for Health Outcomes Research, University of South Florida Health Sciences Center, Tampa FL 33612, USA.
Studnicki
J
J
D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000208:ethnology / Q000601:surgery*; D019992:Databases as Topic; D003710:Demography; D005260:Female; D005431:Florida; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016013:Likelihood Functions; D008408:Mastectomy / Q000191:economics / Q000706:statistics & numerical data*; D015412:Mastectomy, Segmental / Q000191:economics / Q000706:statistics & numerical data*; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data*; D011365:Professional Practice Location / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013531:Surgicenters / Q000706:statistics & numerical data