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Mary Ann Gilligan, MD, MPH; Joan Neuner, MD, MPH; Rodney Sparapani, MS; Purushottam W. Laud, PhD; Ann B. Nattinger, MD, MPH

Arch Surg. 2007;142(1):17-22.

Hypothesis  Adherence to National Institutes of Health consensus statement recommendations for early-stage breast cancer will vary by surgeon characteristics.

Design  Secondary data analysis using the Surveillance, Epidemiology, and End Results national tumor registry linked with Medicare claims data. Logistic regression was used to analyze data on a cohort of 1045 surgeons who operated on 9449 Medicare patients with early-stage breast cancer.

Main Outcome Measure  Care adherent to the 1990 National Institutes of Health consensus statement recommendations.

Results  Surgeon age and specialty were not associated with adherent care overall, nor among breast-conserving surgery or mastectomy subgroups. Patients of higher-volume surgeons were significantly more likely to undergo adherent care overall because of greater use of lymph node dissection among women who received either breast-conserving surgery or mastectomy. Patients of female surgeons and surgeons with a medical school affiliation were less likely to undergo adherent care overall, which was related to greater use of breast-conserving surgery and lesser use of lymph node dissection among patients who underwent breast-conserving surgery.

Conclusions  Several surgeon characteristics are significantly associated with variations in breast cancer treatment received. These results warrant further investigation into the association between these surgeon characteristics and cancer care outcomes.

Author Affiliations: Department of Medicine (Drs Gilligan, Neuner, and Nattinger), the Health Policy Institute (Center for Patient Care and Outcomes Research) (Drs Gilligan, Neuner, Laud, and Nattinger and Mr Sparapani), and Division of Biostatistics (Dr Laud and Mr Sparapani), Medical College of Wisconsin, Milwaukee.

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