FRIDAY, Jan. 7 (HealthDay News) -- How doctors choose to treat
their breast cancer patients -- and whether those treatment choices
follow established recommendations -- may play a larger role in
whether a cancer returns than experts have believed.
In a new analysis looking at 994 women with ductal carcinoma in
situ, the most common type of noninvasive breast cancer,
researchers found treatment variations from surgeon to surgeon are
significant, and may account for up to 30 percent of
"Treatment variation is a troubling but well-known phenomenon in health care," said study author Andrew W. Dick, a researcher at RAND Corp. in Pittsburgh. The report is published online Jan. 3 and in the Jan. 19 print issue of the Journal of the National Cancer Institute.
"The reason it is surprising in this case is that the variation is quite large, and related to factors that are very important in health outcomes," Dick said.
Those factors include having "negative margins" -- meaning that
cancer cells are more than 2 millimeters away from the removed
tissue's edge -- and getting radiation therapy after
The variation by surgeon in treatments accounted for 15 percent
to 35 percent of cancer occurring in the opposite breast in the
next five years and 13 percent to 30 percent of recurrences over 10
years, the investigators found.
The study is well done, said Beth Virnig, a professor of health
policy and management at the University of Minnesota School of
Public Health and co-director of the Cancer Outcomes and
Survivorship Program at the university's Masonic Cancer Center.
She co-wrote an editorial to accompany the study.
"They basically said, after taking into account all this stuff that matters -- how big the tumor is, its grade and which treatment -- it turns out a third of how the patient does is due to their physician," she said.
While Virnig is not surprised at the variations in treatments,
the amount of variation surprised her.
The findings are complex, she said, and so many factors
determine outcome that there is no simple way to guarantee a woman
has the best possible doctor and treatment.
One solution, Virnig said in her editorial, is to develop a kind
of scoring system for breast cancer surgeons. But she acknowledges
that this may not be feasible.
Meanwhile, she suggested that women can boost the odds of
getting optimal treatment by asking their surgeon how many
procedures the doctor does -- with more being better, though she
can't provide a "good enough" number. "Many studies, but not all,
show teaching institutions are better" when it comes to breast
cancer treatments, she said.
If a scoring system were developed, said Dick, "I would like the
system to evolve in such a way that the consumer doesn't have to be
the fully informed expert."
Meanwhile, he said, women facing breast cancer should get their
doctors' views on radiation therapy after breast-conserving surgery
and the importance of negative margins -- both of which are
associated with a lower risk of recurrence.
For more on breast cancer, visit the
U.S. National Cancer Institute.