title: Surgeons' knowledge and practices regarding the role of radiation therapy in breast cancer management.
abstract: OBJECTIVE
  Population-based studies suggest underuse of radiation therapy, especially after mastectomy. Because radiation oncology is a referral-based specialty, knowledge and attitudes of upstream providers, specifically surgeons, may influence patients' decisions regarding radiation, including whether it is even considered. Therefore, we sought to evaluate surgeons' knowledge of pertinent risk information, their patterns of referral, and the correlates of surgeon knowledge and referral in specific breast cancer scenarios.
  
  
  METHODS
  We surveyed a national sample of 750 surgeons, with a 67% response rate. We analyzed responses from those who had seen at least 1 breast cancer patient in the past year (n=403), using logistic regression models to identify correlates of knowledge and appropriate referral.
  
  
  RESULTS
  Overall, 87% of respondents were general surgeons, and 64% saw >10 breast cancer patients in the previous year. In a scenario involving a 45-year-old undergoing lumpectomy, only 45% correctly estimated the risk of locoregional recurrence without radiation therapy, but 97% would refer to radiation oncology. In a patient with 2 of 20 nodes involved after mastectomy, 30% would neither refer to radiation oncology nor provide accurate information to make radiation decisions. In a patient with 4 of 20 nodes involved after mastectomy, 9% would not refer to radiation oncology. Fewer than half knew that the Oxford meta-analysis revealed a survival benefit from radiation therapy after lumpectomy (45%) or mastectomy (32%). Only 16% passed a 7-item knowledge test; female and more-experienced surgeons were more likely to pass. Factors significantly associated with appropriate referral to radiation oncology included breast cancer volume, tumor board participation, and knowledge.
  
  
  CONCLUSIONS
  Many surgeons have inadequate knowledge regarding the role of radiation in breast cancer management, especially after mastectomy. Targeted educational interventions may improve the quality of care.
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Jessica
authors.initials: J
authors.lastname: Zhou
authors.forename: Kent A
authors.initials: KA
authors.lastname: Griffith
authors.forename: Sarah T
authors.initials: ST
authors.lastname: Hawley
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Zikmund-Fisher
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Janz
authors.forename: Michael S
authors.initials: MS
authors.lastname: Sabel
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Katz
authors.forename: Reshma
authors.initials: R
authors.lastname: Jagsi
mesh_terms: D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000401:mortality / Q000517:prevention & control / Q000532:radiotherapy* / Q000601:surgery; D002983:Clinical Competence; D005260:Female; D013502:General Surgery / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology / Q000532:radiotherapy; D008297:Male; D008408:Mastectomy; D015412:Mastectomy, Segmental; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000517:prevention & control; D010818:Practice Patterns, Physicians'; D018787:Radiation Oncology / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012737:Sex Factors; D011795:Surveys and Questionnaires; D047368:Tumor Burden; D014481:United States