Abstract
Breast cancer is a common disease, and the surgical management is continually evolving. The objective of this study was to describe the current breast cancer practice patterns among Canadian surgeons. All active General Surgeons (n = 1172), as accredited by the Royal College of Physicians and Surgeons of Canada, were sent a 31-item questionnaire. Anonymous responses were collected and analyzed regarding surgeon demographics, practice, and perceptions regarding surgical care of breast cancer patients. Overall 640 active surgeons responded; of these, 519 (81%) treated breast cancer and formed the study cohort. Practice settings included community (55%), community with university affiliation (28%), and academic (17%). The majority of surgeons (76%) stated that < 25% of their practice was devoted to breast disease, and 42% performed ≤ 2 breast cancer operations/month. Immediate breast reconstruction (IBR) was used by 57% of surgeons. On multivariate analysis, higher surgeon volume of breast cancer cases (p = 0.0008), fellowship training in Surgical Oncology (p = 0.009), community population (p = 0.001), and academic practice setting (p < 0.0001) were independently associated with the use of IBR. Of the 640 surgeons who responded, 79% stated that breast cancer surgery should be performed by “most general surgeons.” In Canada, most breast cancer surgery was performed by general surgeons who did not appear to have an interest, as defined by training or clinical volume, in breast cancer. Although variability regarding specific surgical issues was found among subgroups of surgeons, the majority of respondents felt that most general surgeons should treat breast cancer.
Similar content being viewed by others
References
National Cancer Institute of Canada. Canadian Cancer Statistics 2001, Toronto, Canada, 2001
JC Bloodgood (1930) ArticleTitleProblems of cancer J. Kansas Med. Soc. 31 311–316
U Veronesi A Banfi M Vecchio ParticleDel et al. (1986) ArticleTitleComparison of Halsted mastectomy with quadrantectomy, axillary dissection, and radiotherapy in early breast cancer: long-term results Eur. J. Cancer Clin. Oncol. 22 1085–1089 Occurrence Handle1:STN:280:BiiD2Mvhs1U%3D Occurrence Handle3536526
B Fisher S Anderson J Bryant et al. (2002) ArticleTitleTwenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer N. Engl. J. Med. 347 1233–1241 Occurrence Handle10.1056/NEJMoa022152 Occurrence Handle12393820
D Sarrazin MG Lê R Arriagada et al. (1989) ArticleTitleTen-year results of a randomized trial comparing a conservative treatment to mastectomy in early breast cancer Radiother. Oncol. 14 177–184 Occurrence Handle1:STN:280:BiaB387msVw%3D Occurrence Handle2652199
RC Blichert-Toft JA Andersen M Overgaard et al. (1992) ArticleTitleDanish randomized trial comparing breast conservation therapy with mastectomy: six years of life-table analysis J. Natl. Cancer Inst. Monogr. 11 19–25 Occurrence Handle1627427
AS Lichter ME Lippman DN Danforth et al. (1992) ArticleTitleMastectomy versus breast-conserving therapy in the treatment of stage I and II carcinoma of the breast: a randomized trial at the National Cancer Institute J. Clin. Oncol. 10 976–983 Occurrence Handle1:STN:280:By2B28fpsFA%3D Occurrence Handle1588378
JA Dongen Particlevan H Bartelink IS Fentiman et al. (1992) ArticleTitleRandomized clinical trial to assess the value of breast-conserving therapy in stage I and II breast cancer, EORTC 10801 Trial J. Natl. Cancer Inst. Monogr. 11 15–18 Occurrence Handle1627421
InstitutionalAuthorNameEarly Breast Cancer Trialists Collaborative Group (1995) ArticleTitleEffects of radiotherapy and surgery in early breast cancer: an overview of the randomized trials N. Engl. J. Med. 333 1444–1455
B Fisher A Brown E Mamounas et al. (1997) ArticleTitleEffect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18 J. Clin. Oncol. 15 2483–2493 Occurrence Handle1:CAS:528:DyaK2sXkslymsr8%3D Occurrence Handle9215816
AU Buzdar SE Singletary DJ Booser et al. (1995) ArticleTitleCombined modality treatment of stage III and inflammatory breast cancer: M.D. Anderson Cancer Center experience Surg. Oncol. Clin. North Am. 4 715–734 Occurrence Handle1:STN:280:BymC3MbgtVQ%3D
G Bonadonna P Valagussa C Brambilla et al. (1998) ArticleTitlePrimary chemotherapy in operable breast cancer: eight-year experience at the Milan Cancer Institute J. Clin. Oncol. 16 93–100 Occurrence Handle1:STN:280:DyaK1c7gtFKkug%3D%3D Occurrence Handle9440728
AE Giuliano DM Kirgan JM Guenther et al. (1994) ArticleTitleLymphatic mapping and sentinel lymphadenectomy for breast cancer Ann. Surg. 230 390–401
U Veronesi G Paganelli G Viale et al. (1999) ArticleTitleSentinel lymph node biopsy and axillary dissection in breast cancer: results in a large series J. Natl. Cancer Inst. 91 368–373 Occurrence Handle10.1093/jnci/91.4.368 Occurrence Handle1:STN:280:DyaK1M7lvVWmug%3D%3D Occurrence Handle10050871
CE Cox F Haddad S Bass et al. (1998) ArticleTitleLymphatic mapping in the treatment of breast cancer Oncology 12 1283–1292 Occurrence Handle1:STN:280:DyaK1cvltFKqtQ%3D%3D Occurrence Handle9778675
D Krag D Weaver T Ashikaga et al. (1998) ArticleTitleThe sentinel node in breast cancer: a multicenter validation study N. Engl. J. Med. 339 941–946 Occurrence Handle1:STN:280:DyaK1cvhvVKntg%3D%3D Occurrence Handle9753708
KM McMasters SL Wong C Chao et al. (2001) ArticleTitleDefining the optimal surgeon experience for breast cancer sentinel lymph node biopsy: a model for implementation of new surgical techniques Ann. Surg. 234 292–299 Occurrence Handle10.1097/00000658-200109000-00003 Occurrence Handle1:STN:280:DC%2BD3Mrjt1ynsA%3D%3D Occurrence Handle11524582
CE Cox SS Bass D Boulware et al. (1999) ArticleTitleImplementation of new surgical technology: outcome measures for lymphatic mapping of breast carcinoma Ann. Surg. Oncol. 6 553–561 Occurrence Handle1:STN:280:DyaK1MvitFeltA%3D%3D Occurrence Handle10493623
RT Patel DJ Webster RE Mansel et al. (1993) ArticleTitleIs immediate postmastectomy reconstruction safe in the long term? Eur. J. Surg. Oncol. 19 372–375 Occurrence Handle1:STN:280:ByyA28rmsVw%3D Occurrence Handle8359285
SE Singletary (1997) ArticleTitleSkin-sparing mastectomy with immediate breast reconstruction: the M. D. Anderson Cancer Center experience Ann. Surg. Oncol. 3 411–416
RM Simmons SK Fish L Gayle et al. (1999) ArticleTitleLocal and distant recurrence rates in skin-sparing mastectomies compared with non-skin-sparing mastectomies Ann. Surg. Oncol. 6 676–681 Occurrence Handle1:STN:280:DC%2BD3c%2FitlGisg%3D%3D Occurrence Handle10560854
Porter GA, MacMulkin H. Sentinel lymph node biopsy practice patterns in breast cancer: the Canadian perspective. Ann. Surg. Oncol. In Press
AB Nattinger MS Gottlieb J Veum et al. (1992) ArticleTitleGeographic variation in the use of breast-conserving treatment for breast cancer N. Engl. J. Med. 326 1102–1107 Occurrence Handle1:STN:280:By2B3cvhvFY%3D Occurrence Handle1552911
DC Farrow WC Hunt M Samet (1992) ArticleTitleGeographic variation in the treatment of localized breast cancer N. Engl. J. Med. 326 1097–1101 Occurrence Handle1:STN:280:By2B3cvhvFU%3D Occurrence Handle1552910
NA Iscoe V Goel K Wu et al. (1994) ArticleTitleVariation in breast cancer surgery in Ontario Can. Med. Assoc. J. 150 345–363 Occurrence Handle1:STN:280:ByuC38zhvFU%3D
E Guadagnoli JC Weeks CL Shapiro et al. (1998) ArticleTitleUse of breast-conserving surgery for treatment of stage I and stage II breast cancer J. Clin. Oncol. 16 101–106 Occurrence Handle1:STN:280:DyaK1c7gtFKkuw%3D%3D Occurrence Handle9440729
C Sawka I Olivotto A Coldman et al. (1997) ArticleTitleThe association between population-based treatment guidelines and adjuvant therapy for node-negative breast cancer Br. J. Cancer 75 1534–1542 Occurrence Handle1:STN:280:ByiA3cbltlE%3D Occurrence Handle9166950
E Guadagnoli CL Shapiro JC Weeks et al. (1998) ArticleTitleThe quality of care for treatment of early stage breast carcinoma: is it consistent with national guidelines? Cancer 83 302–309 Occurrence Handle10.1002/(SICI)1097-0142(19980715)83:2<302::AID-CNCR14>3.3.CO;2-C Occurrence Handle1:STN:280:DyaK1czjt1CktA%3D%3D Occurrence Handle9669813
TP Johnson L Ford RB Warnecke et al. (1994) ArticleTitleEffect of a National Cancer Institute Clinical Alert on breast cancer practice patterns J. Clin. Oncol. 12 1783–1788 Occurrence Handle1:STN:280:ByuA28rmt1Y%3D Occurrence Handle8083701
BE Hillner TJ Smith CE Desch (2000) ArticleTitleHospital physician volume specialization outcomes cancer treatment importance quality cancer care J. Clin. Oncol. 18 2327–2340 Occurrence Handle1:STN:280:DC%2BD3c3ptFahsg%3D%3D Occurrence Handle10829054
JA Sosa HM Bowman TA Gordon et al. (1998) ArticleTitleImportance of hospital volume in the overall management of pancreatic cancer Ann. Surg. 228 429–438 Occurrence Handle10.1097/00000658-199809000-00016 Occurrence Handle1:STN:280:DyaK1cvhtlymug%3D%3D Occurrence Handle9742926
JD Birkmeyer AL Warshaw SR Finlayson et al. (1999) ArticleTitleRelationship between hospital volume and late survival after pancreaticoduodenectomy Surgery 126 178–183 Occurrence Handle10.1067/msy.1999.98741 Occurrence Handle1:STN:280:DyaK1MzosVyhsQ%3D%3D Occurrence Handle10455881
CB Begg LD Cramer WJ Hoskins et al. (1998) ArticleTitleImpact of hospital volume on operative mortality for major cancer surgery JAMA 280 1747–1751 Occurrence Handle1:STN:280:DyaK1M%2FlslSrsQ%3D%3D Occurrence Handle9842949
MG Patti CU Corvera RE Glasgow et al. (1998) ArticleTitleA hospital’s annual rate of esophagectomy influences the operative mortality rate J. Gastrointest. Surg. 2 186–192 Occurrence Handle10.1016/S1091-255X(98)80011-5 Occurrence Handle1:STN:280:DyaK1M%2FlvF2mug%3D%3D Occurrence Handle9834415
HN Nguyen HE Averette W Hoskins et al. (1993) ArticleTitleNational survey of ovarian carcinoma: Part V—the impact of physician’s specialty on patients’ survival Cancer 72 3663–3670 Occurrence Handle1:STN:280:ByuD2szotFU%3D Occurrence Handle8252483
GA Porter CL Soskolne WW Yakimets et al. (1998) ArticleTitleSurgeon-related factors and outcome in rectal cancer Ann. Surg. 227 157–167 Occurrence Handle10.1097/00000658-199802000-00001 Occurrence Handle1:STN:280:DyaK1c7kslygtg%3D%3D Occurrence Handle9488510
CS McCardle D Hole (1991) ArticleTitleImpact of variability among surgeons on postoperative mortality and morbidity and ultimate survival Br. Med. J. 302 1501–1505
AJ Simons R Ker . Groshen et al. (1997) ArticleTitleVariations in treatment of rectal cancer: the influence of hospital type and caseload Dis. Colon Rectum 40 641–646 Occurrence Handle1:STN:280:ByiA3sjns1Y%3D Occurrence Handle9194456
T Holm H Johansson B Cedermark et al. (1997) ArticleTitleInfluence of hospital- and surgeon-related factors on outcome after treatment of rectal cancer with or without preoperative radiotherapy Br. J. Surg. 84 657–663 Occurrence Handle10.1046/j.1365-2168.1997.02745.x Occurrence Handle1:STN:280:ByiA3MrnsFQ%3D Occurrence Handle9171755
R Sainsbury B Haward L Rider et al. (1995) ArticleTitleInfluence of clinician workload and patterns of treatment on survival from breast cancer Lancet 345 1265–1270 Occurrence Handle1:STN:280:ByqB28votFM%3D Occurrence Handle7746056
CR Gillis DJ Hole (1996) ArticleTitleSurvival outcome of care by specialist surgeons in breast cancer: a study of 3786 patients in the west of Scotland BMJ 312 145–148 Occurrence Handle1:STN:280:BymC2M3gt1Q%3D Occurrence Handle8563532
PJ Roohan NA Bickell MS Baptiste et al. (1998) ArticleTitleHospital volume differences and five-year survival from breast cancer Am. J. Public Health 88 454–457 Occurrence Handle1:STN:280:DyaK1c7nvFCrtA%3D%3D Occurrence Handle9518982
E Kapiteijn H Putter CJ Velde Particlevan de (2002) ArticleTitleImpact The Netherlands Br. J. Surg. 89 1142–1149 Occurrence Handle10.1046/j.1365-2168.2002.02196.x Occurrence Handle1:STN:280:DC%2BD38vjsVWitw%3D%3D Occurrence Handle12190680
LJ Lester (1979) ArticleTitleA critical viewpoint by a general surgeon toward reconstructive surgery after mastectomy Clin. Plast. Surg. 6 15–17 Occurrence Handle1:STN:280:CSaC1M%2FktFI%3D Occurrence Handle445970
RB Noone TG Frazier GC Noone et al. (1994) ArticleTitleRecurrence of breast carcinoma following immediate reconstruction: a 13-year review Plast. Reconstr. Surg. 93 96–106 Occurrence Handle1:STN:280:ByuC3crivVQ%3D Occurrence Handle8278489
M Morrow SK Scott HR Menck et al. (2001) ArticleTitleFactors influencing the use of breast reconstruction postmastectomy: a National Cancer Database study J. Am. Coll. Surg. 192 1–8 Occurrence Handle10.1016/S1072-7515(00)00747-X Occurrence Handle1:STN:280:DC%2BD3M%2FpsVyiuw%3D%3D Occurrence Handle11192909
RM Groves (1989) Survey Errors and Survey Costs John Wiley and Sons New York
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Porter, G., McMulkin-Tait, H. Practice Patterns in Breast Cancer Surgery: Canadian Perspective. World J. Surg. 28, 80–86 (2004). https://doi.org/10.1007/s00268-003-7040-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-003-7040-6