Surgeon perspectives about local therapy for breast carcinoma.
BACKGROUND
Geographic variations in the use of mastectomy and the use of radiation therapy (RT) after breast-conserving surgery (BCS) have motivated concerns that surgeons are not uniformly adhering to treatment standards.


METHODS
The authors surveyed attending surgeons of a population-based sample of patients with breast carcinoma diagnosed in Detroit and Los Angeles from December 2001 to January 2003 (n = 365; response rate, 80.0%). Clinical scenarios were used to evaluate opinions about local therapy.


RESULTS
On average, surgeons reported that they devoted 31.3% of their total practice to breast carcinoma. Approximately one-half of surgeons practiced in a community hospital setting, whereas 18.8% practiced in a cancer center. Compared to low volume surgeons, high volume surgeons were more likely to favor BCS with RT for invasive breast carcinoma (60.8%, 74.0%, and 87.2% for low, moderate, and high volume surgeons, respectively, P < 0.001). Surgeons who favored BCS were more likely to perceive greater quality of life (QOL) benefits for BCS than mastectomy (85.9%) compared with surgeons who favored mastectomy (28.6%) and those who did not favor 1 procedure over the other (60.0%, P < 0.001). In a ductal carcinoma in situ scenario, 35.0% of surgeons favored BCS without RT and 61.0% favored BCS with RT. Opinions regarding the role of RT after BCS varied by geographic site, surgeon volume, and patient age.


CONCLUSIONS
Variation in surgeon opinion concerning local therapy reflected clinical uncertainty about the benefits of alternative treatments. High volume surgeons more frequently endorsed current clinical guidelines that favor BCS compared with mastectomy. This may partly be explained by the greater belief that BCS confers a better patient QOL than mastectomy.
Katz
Steven J
SJ
Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109-0429, USA. skatz@umich.edu
Lantz
Paula M
PM
Janz
Nancy K
NK
Fagerlin
Angela
A
Schwartz
Kendra
K
Liu
Lihua
L
Deapen
Dennis
D
Salem
Barbara
B
Lakhani
Indu
I
Morrow
Monica
M
D000328:Adult; D000367:Age Factors; D000368:Aged; D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D013502:General Surgery; D006801:Humans; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D011364:Professional Practice; D011788:Quality of Life; D011795:Surveys and Questionnaires