title: Breast cancer management and outcome according to surgeon's affiliation: a population-based comparison adjusted for patient's selection bias.
abstract: BACKGROUND
  Studies have reported that breast cancer (BC) units could increase the quality of care but none has evaluated the efficacy of alternative options such as private BC networks, which is our study objective.
  
  
  METHODS
  We included all 1404 BC patients operated in the public unit or the private network and recorded at the Geneva Cancer Registry between 2000 and 2005. We compared quality indicators of care between the public BC unit and the private BC network by logistic regression and evaluated the effect of surgeon's affiliation on BC-specific mortality by the Cox model adjusting for the propensity score.
  
  
  RESULTS
  Both the groups had high care quality scores. For invasive cancer, histological assessment before surgery and axillary lymph node dissection when indicated were less frequent in the public sector (adjusted odds ratio (OR): 0.4, 95% confidence interval (CI) 0.3-0.7, and OR: 0.4, 95% CI 0.2-0.8, respectively), while radiation therapy after breast-conserving surgery was more frequent (OR: 2.5, 95% CI 1.4-4.8). Surgeon affiliation had no substantial effect on BC-specific mortality (adjusted hazard ratio (HR): 0.8, 95% CI 0.5-1.4).
  
  
  CONCLUSIONS
  This study suggests that private BC networks could be an alternative to public BC units with both structures presenting high quality indicators of BC care and similar BC-specific mortality.
authors.affiliation: SONGe (Séno ONcologie Genevoise), Geneva Private Practitioners Breast Cancer Network, Geneva, Switzerland.
authors.forename: F
authors.initials: F
authors.lastname: Taban
authors.forename: E
authors.initials: E
authors.lastname: Rapiti
authors.forename: G
authors.initials: G
authors.lastname: Fioretta
authors.forename: Y
authors.initials: Y
authors.lastname: Wespi
authors.forename: D
authors.initials: D
authors.lastname: Weintraub
authors.forename: A
authors.initials: A
authors.lastname: Hugli
authors.forename: H
authors.initials: H
authors.lastname: Schubert
authors.forename: G
authors.initials: G
authors.lastname: Vlastos
authors.forename: M
authors.initials: M
authors.lastname: Castiglione
authors.forename: C
authors.initials: C
authors.lastname: Bouchardy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011787:Quality of Health Care; D015983:Selection Bias; D013557:Switzerland / Q000453:epidemiology