title: The quality of preoperative diagnostics and surgery and their impact on delays in breast cancer treatment - A population based study.
abstract: OBJECTIVE
  This study aims to clarify quality of breast cancer surgery in population-based setting. We aim to elucidate factors influencing waiting periods, and to evaluate the effect of hospital volume on surgical treatment policies. Special interest was given to diagnostic and surgical processes and their impact on waiting times.
  
  
  METHODS
  All 1307 patients having primary breast cancer surgery at the Helsinki and Uusimaa Hospital District during 2010 were included in this retrospective study.
  
  
  RESULTS
  Median waiting time for primary surgery was 24 days and significantly affected by additional imaging and diagnostic biopsies as well as hospital volume. Final rate of breast conserving surgery was surprisingly low, 51%, not affected by hospital volume, p = 0.781. Oncoplastic resection and immediate breast reconstruction (IBR) were performed more often in high volume units, p < 0.001. Quality of axillary surgery varied with unit size. Multiple operations, IBR and high volume unit were factors prolonging initiation of adjuvant treatment.
  
  
  CONCLUSIONS
  Quality of preoperative diagnostics play a crucial role in minimizing the need of repeated imaging and biopsies as well as multiple operations. Positive impact of high-volume hospitals becomes evident when analyzing procedures requiring advanced surgical techniques. High-volume hospitals achieved better quality in axillary surgery.
authors.affiliation: Breast Surgery Unit, Comprehensive Cancer Center, Helsinki University Hospital and Helsinki University, P.O.Box 263, 00029 HUS, Finland. Electronic address: kaisu.ojala@helsinki.fi.
authors.forename: Kaisu
authors.initials: K
authors.lastname: Ojala
authors.affiliation: Breast Surgery Unit, Comprehensive Cancer Center, Helsinki University Hospital and Helsinki University, P.O.Box 263, 00029 HUS, Finland.
authors.forename: Tuomo J
authors.initials: TJ
authors.lastname: Meretoja
authors.affiliation: Department of Oncology, Helsinki University Hospital and Helsinki University, P.O. Box 180, 00029 HUS, Finland.
authors.forename: Johanna
authors.initials: J
authors.lastname: Mattson
authors.affiliation: Hyvinkää Hospital, Department of Surgery, Sairaalakatu 1, 05850, Hyvinkää, Finland.
authors.forename: Päivi
authors.initials: P
authors.lastname: Salminen-Peltola
authors.affiliation: Porvoo Hospital, Department of Surgery, Sairaalantie 1, 06100, Porvoo, Finland.
authors.forename: Suvi
authors.initials: S
authors.lastname: Leutola
authors.affiliation: Tammisaari Hospital, Department of Surgery, P.O.Box 1020, 10600, Raasepori, Finland.
authors.forename: Marianne
authors.initials: M
authors.lastname: Berggren
authors.affiliation: Breast Surgery Unit, Comprehensive Cancer Center, Helsinki University Hospital and Helsinki University, P.O.Box 263, 00029 HUS, Finland.
authors.forename: Marjut H K
authors.initials: MH
authors.lastname: Leidenius
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D006767:Hospitals, District / Q000592:standards / Q000706:statistics & numerical data; D061847:Hospitals, High-Volume / Q000592:standards / Q000706:statistics & numerical data; D061846:Hospitals, Low-Volume / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods / Q000592:standards*; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D061665:Time-to-Treatment / Q000706:statistics & numerical data
keywords: Breast cancer; Quality of care; Surgery; Treatment delay; Waiting time