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Diffusion of Surgical Techniques in Early Stage Breast Cancer: Variables Related to Adoption and Implementation of Sentinel Lymph Node Biopsy

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Understanding how physicians acquire and adopt new technologies for cancer diagnosis and treatment is poorly understood, yet is critical to the dissemination of evidence-based practices. Sentinel lymph node biopsy (SLNB) has recently become a standard technique for axillary staging in early breast cancer and is an ideal platform for studying medical technology diffusion. We sought to describe the timing of SLNB adoption and patterns of surgeon interactions with the following educational sources: local university training program, surgical literature, national meetings/courses, national specialty centers, and other local surgeons.

Methods

A cross-sectional survey that used semistructured interviews was used to assess timing of adoption, practice patterns, and learning sources for SLNB among surgical oncologists and general surgeons in a single metropolitan area.

Results

A total of 44 eligible surgeons were identified; 38 (86%) participated. All surgical oncologists (11 of 11) and most general surgeons (26 of 27) had implemented SLNB. Surgical oncologists were older (mean 51 vs. 48 years, P = .02) and had used SLNB longer (6.1 vs. 3.3 years, P = .01) than general surgeons. By use of social network diagrams, surgical oncologists and the university training program were shown to be key intermediaries between general surgeons and national specialty centers. Surgeons in group practice tended to use more learning sources than solo practitioners.

Conclusions

Surgical oncologists and university-based surgeons play key educational roles in disseminating new cancer treatments and therefore have a professional responsibility to educate other community physicians to increase the use of the most current, evidence-based practices.

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ACKNOWLEDGMENTS

Presented in part at the 77th Annual Meeting of the Pacific Coast Surgical Association, February 17–20, 2006, San Francisco, CA.

This research was supported by a K30 Mentored Clinical Research Training Grant from the University of California–Davis School of Medicine. We thank all of the surgeons who volunteered their time and experiences to this research.

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Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology, University of California, Davis, Cancer Center, 4501 X Street, Suite 3010, Sacramento, California, 95817

    Kimberly A. Vanderveen MD & Richard J. Bold MD

  2. Center for Health Services Research in Primary Care, University of California, Davis, Sacramento, California

    Debora A. Paterniti PhD & Richard L. Kravitz MSPH, MD

  3. Department of Sociology, University of California, Davis, Davis, California

    Debora A. Paterniti PhD

Authors
  1. Kimberly A. Vanderveen MD
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  2. Debora A. Paterniti PhD
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  3. Richard L. Kravitz MSPH, MD
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  4. Richard J. Bold MD
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Correspondence to Richard J. Bold MD.

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Vanderveen, K.A., Paterniti, D.A., Kravitz, R.L. et al. Diffusion of Surgical Techniques in Early Stage Breast Cancer: Variables Related to Adoption and Implementation of Sentinel Lymph Node Biopsy. Ann Surg Oncol 14, 1662–1669 (2007). https://doi.org/10.1245/s10434-006-9336-x

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  • DOI: https://doi.org/10.1245/s10434-006-9336-x

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