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Lumpectomy Rate Depends More on Surgeon, Not Location

Lumpectomy Rate Depends More on Surgeon, Not Location

CHICAGO—Rates of breast-conserving surgery for breast cancer typically are lower in the Southeast than in other parts of the United States. According to a study presented at the 86th Annual Meeting of the Radiological Society of North America (RSNA), this difference has less to do with geography than with the surgeon who treats the patient.

Lillian H. Rinker, MD, a radiation oncologist at Methodist Healthcare-Central Hospital, Memphis, Tennessee, reported the results.

Dr. Rinker and her associate, Stephen T. Lutz, MD, also a radiation oncologist at Methodist Healthcare-Central Hospital, reviewed data at their institution from 196 women with breast cancer, 172 newly diagnosed with the disease; 148 of these women were eligible for lumpectomy and radiation therapy because they had stage Tis, T1, or T2 disease.

Of the five most active breast surgeons treating these women, the rates of breast conservation varied from 11% to 81%.

"Because of this variation among women who all lived in the same area, we believe that geography probably plays a much less important role in whether a woman gets conservation therapy than does the physician with whom she interacts when she makes the decision," Dr. Rinker said.

Dr. Rinker also reported that the rate of breast-conserving surgery at Methodist Healthcare-Central Hospital increased between 1998 and 1999 because of the institution of a multidisciplinary breast cancer conference created to study patterns of care, make prospective treatment recommendations, and help increase communication among physicians who treat breast cancer.

The rate of breast-conserving surgery in the hospital was 33% in 1996 and 37% in 1998, which is below the national average of 45% to 60%. One year after the conference was established, the rate rose to 47%. Dr. Rinker attributed this increase to physician education.

The weekly conference includes all specialists involved in the management of breast cancer, including surgeons, pathologists, radiologists, radiation oncologists, and medical oncologists.

During the conference, physicians review all available clinical information as well as mammographic and pathologic data before reaching a consensus treatment recommendation. If the referring physician is not able to be at the conference, he or she receives a fax detailing the recommendations.

Interaction Among Peers

The value of the conference, Dr. Rinker believes, relates to the interaction among physician peers.

"The radiation oncologists, radiologists, and pathologists help to show the referring physicians what they are dealing with so they can make the best treatment plan, whether it is surgery alone or surgery followed by chemotherapy and radiation," she said.

During the conference, she noted, "the surgeon is able to have a mammogram interpreted by a radiologist, to see the pathology on the slide, to ask the radiation oncologist, ‘If I do a lumpectomy instead of a mastectomy, are you willing to go ahead and treat this patient with radiation therapy?’"

As a result of the conference, she concluded, "whoever first encounters the patient and helps her make a decision is a little more knowledgeable and able to offer more options."

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