Whether a woman receives radiation after breast cancer surgery may be associated with certain characteristics of her surgeon, including sex and medical training, according to a new study.
Many breast cancer patients do not receive radiation after undergoing breast conservation surgery, despite the fact that this treatment is considered a standard of quality cancer care and has been shown to reduce breast cancer recurrence. Previous studies have shown that certain patient characteristics, such as a patient's race and distance from a radiation therapy facility, are associated with receiving post-surgical radiation. But it has been unclear whether physician characteristics also play a role in the quality of breast cancer care.
Dawn Hershman, M.D., of Herbert Irving Comprehensive Cancer Center at Columbia University in New York and colleagues investigated whether surgeon characteristics were associated with a patient receiving radiation after breast cancer surgery. They identified and analyzed data on nearly 30,000 women aged 65 and older with breast cancer who were diagnosed between 1991 and 2002 and who received breast-conserving surgery. They also collected information on the 4,453 surgeons who operated on these women--including their sex, year of graduation, medical school location, patient volume, and type of medical degree.
About 75 percent of the women received radiation after surgery. Each year from 1991 to 2002, the proportion of women receiving radiation increased. Nonetheless, older women, black women, unmarried women, and those living outside urban areas were less likely to receive radiation. After adjusting for patient and tumor characteristics, the researchers found that women who received radiation were more likely to have a surgeon who was female, had an M.D. degree (compared to a D.O. degree), or was trained in the United States.
"Our study is one of the first to demonstrate associations between certain surgeon characteristics and quality of breast cancer care... If confirmed, more research is needed on whether they reflect surgeon behavior, patient response, or physician-patient interactions," the authors write.
Citation: Hershman DL, Buono D, McBride RB, Tsai WY, Joseph KA, Grann VR, Jacobson JS. Surgeon Characteristics and Receipt of Adjuvant Radiotherapy in Women With Breast Cancer. J Natl Cancer Inst 2008; 100:199-206
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