title: The effect of dedicated breast surgeons on the short-term outcomes in breast cancer.
abstract: OBJECTIVE
  The impact of breast surgeons on short-term outcomes in breast cancer care was compared at a single institution.
  
  
  BACKGROUND
  Many studies have demonstrated a correlation between high procedural volume and lower mortality in technically challenging procedures. Breast cancer treatment has significant impact on patient behavior, psychology, and appearance. Therefore, evaluation of outcomes cannot be limited to only operative mortality and morbidity. We sought to determine the effect of dedicated breast cancer surgeons on short-term outcomes at a single institution.
  
  
  METHODS
  Wishard Memorial Hospital is the county hospital affiliated with the Indiana University School of Medicine. A retrospective review was performed of all patients from January 1, 1997, to February 28, 2006. On July 1, 2003, coverage for the Breast Clinic was changed from general surgeons (G) to breast surgeons (B). There were 596 patients included in the study period.
  
  
  RESULTS
  There were no significant differences in patient demographics or disease characteristics between the 2 time periods. For early stage (stage I and II) breast cancer, a higher percentage of patients underwent breast conservation in the breast surgeon period than in the general surgeon period (P = 0.04). Lumpectomy margins in breast conserving operations during the G period were more often positive (P = 0.025) or close (<1 mm) (P = 0.01). Similarly, the rates of re-excision lumpectomy were also significantly lower during the B period (21% vs. 39%, respectively, P = 0.01). Breast surgeons were more likely to perform the sentinel node procedure (P = 0.001). There were no differences in the use of adjuvant chemotherapy and radiation therapy. The use of hormonal manipulation, however, was significantly higher in the B group than in the G group (P < 0.0002).
  
  
  CONCLUSIONS
  Surgeons specialized in diseases of the breast demonstrate significant improvement in short-term outcomes associated with breast cancer treatment at a single institution. The differences identified cannot be attributed to differences in institutional function, patient population, surgeon case volume, or on the influence of nonsurgeon physicians.
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indiana University, Indianapolis, Indiana, USA.
authors.forename: Noelia M
authors.initials: NM
authors.lastname: Zork
authors.forename: Ian K
authors.initials: IK
authors.lastname: Komenaka
authors.forename: Robert E
authors.initials: RE
authors.lastname: Pennington
authors.forename: Monet W
authors.initials: MW
authors.lastname: Bowling
authors.forename: Laura E
authors.initials: LE
authors.lastname: Norton
authors.forename: Susan E
authors.initials: SE
authors.lastname: Clare
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goulet
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D002983:Clinical Competence; D018572:Disease-Free Survival; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy / Q000009:adverse effects / Q000379:methods*; D015412:Mastectomy, Segmental / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D017060:Patient Satisfaction; D011336:Probability; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000706:statistics & numerical data*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome