Cancer Research Lab

Surgeon characteristics, such as gender or country of training, appear to influence whether a women with breast cancer will receive adjuvant radiotherapy, according to a report in the Journal of the National Cancer Institute for February 6.

The Agency for Healthcare Research and Quality considers radiotherapy after breast conservation surgery (BCS) as a quality of care indicator, yet many do not receive this treatment, comment Dr. Dawn L. Hershman and colleagues from Columbia University in New York. The goal of the present study was to determine whether surgeon-related factors play a role in the receipt of post-BCS radiotherapy.

To do this, the researchers analyzed data from 29,760 women, aged 65 years or older, who underwent BCS for stage I/II breast cancer from 1991 and 2002 and were entered in a Surveillance, Epidemiology, and End-Results-Medicare linked database. Surgeon characteristics were assessed using information in the American Medical Association Masterfile.

Overall, 75% of the women received adjuvant radiotherapy, the report indicates. Women given radiotherapy were younger, had fewer comorbidities and were more often white, married, from an urban area, and were typically diagnosed in a later year than those not treated with radiotherapy.

Patients given radiotherapy were more likely to have a female surgeon (79% vs. 73%), one with an MD rather than DO degree (75% vs. 68%), and one who trained in the US rather than elsewhere (75% vs. 70%). Having a surgeon with 15 or more patients also raised the likelihood of receiving radiotherapy.

“Our study is one of the first to demonstrate associations between certain surgeon characteristics and quality of breast cancer care,” Dr. Hershman and colleagues conclude. “If confirmed, more research is needed on whether they reflect surgeon behavior, patient response, or physician-patient interactions.”