title: Patterns and correlates of patient referral to surgeons for treatment of breast cancer.
abstract: OBJECTIVE
  Characteristics of surgeons and their hospitals have been associated with cancer treatments and outcomes. However, little is known about factors that are associated with referral pathways.
  
  
  METHODS
  We analyzed tumor registry and survey data from women with breast cancer diagnosed in 2002 and reported to the Detroit and Los Angeles Surveillance, Epidemiology, and End Results registries (n = 1,844; response rate, 77.4%) and their attending surgeons (n = 365; response rate 80.0%).
  
  
  RESULTS
  About half of the patients (54.3%) reported that they were referred to the surgeon by another provider or health plan; 20.3% reported that they selected the surgeon; and 21.9% reported that they both were referred and were involved in selecting the surgeon. Patients who selected the surgeon based on reputation were more likely to have received treatment from a high-volume surgeon (adjusted odds ratio [OR], 2.2; 95% CI, 1.5 to 3.4) and more likely to have been treated in an American College of Surgeons-approved cancer program or a National Cancer Institute (NCI) -designated cancer center (adjusted OR, 2.0; 95% CI, 1.3 to 3.1; adjusted OR, 3.4; 95% CI, 1.9 to 6.2, respectively). Patients who were referred to the surgeon were less likely to be treated in an NCI-designated cancer center (adjusted OR, 0.5; 95% CI, 0.3 to 0.9).
  
  
  CONCLUSIONS
  Women with breast cancer who actively participate in the surgeon selection process are more likely to be treated by more experienced surgeons and in hospitals with cancer programs. Patients should be aware that provider or health plan-based referral may not connect them with the most experienced surgeon or comprehensive practice setting in their community.
authors.affiliation: Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109-0429, USA. skatz@umich.edu
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Katz
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Hofer
authors.forename: Sarah
authors.initials: S
authors.lastname: Hawley
authors.forename: Paula M
authors.initials: PM
authors.lastname: Lantz
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Janz
authors.forename: Kendra
authors.initials: K
authors.lastname: Schwartz
authors.forename: Lihua
authors.initials: L
authors.lastname: Liu
authors.forename: Dennis
authors.initials: D
authors.lastname: Deapen
authors.forename: Monica
authors.initials: M
authors.lastname: Morrow
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000601:surgery*; D005260:Female; D013502:General Surgery / Q000592:standards / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D008408:Mastectomy / Q000592:standards / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio; D010358:Patient Participation; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018426:SEER Program / Q000706:statistics & numerical data; D000078329:Workforce