Surgeon influence on receipt of contralateral prophylactic mastectomy: Does it matter who you see for breast cancer surgery?

Details

• Alternative Title:
  JAMA Surg
• Personal Author:
  Katz, Steven J. ; Hawley, Sarah T. ; Hamilton, Ann S. ; Ward, Kevin C. ; Morrow, Monica ; Jagsi, Reshma ; Hofer, Timothy P.
• Description:
  Importance ; Rates of contralateral prophylactic mastectomy (CPM) have markedly increased but we know little about the influence of surgeons on variability of the procedure in the community. ; Objective ; To quantify the influence of attending surgeon on rates of CPM and clinician attitudes that explained it. ; Design and Setting ; Population-based survey study in Georgia and Los Angeles County. ; Participants ; We identified 7810 women with stages 0-II breast cancer treated in 2013–15 through the Surveillance, Epidemiology, and End Results (SEER) registries of Georgia and Los Angeles County. Surveys were sent approximately 2 months after surgery, (70% response rate, n=5080). Surveys were also sent to 488 attending surgeons identified by the patients, of whom 377 responded (77% response rate). ; Main Outcomes and Measures ; We conducted multilevel analyses to examine the impact of surgeon influence on variations in patient receipt of CPM using information from patient and surgeon surveys merged to SEER data. ; Results ; The patient mean age was 62; 30% had an increased risk of 2nd primary cancer, and 16% received CPM. Half of surgeons (52%) practiced for >20 years and 30% treated >50 new breast cancer patients annually. Attending surgeon explained a large amount (20%) of the variation in CPM controlling for patient factors. The odds of a patient receiving CPM increased almost 3-fold (OR 2.8, 95% CI 2.1,3.4) if she saw a surgeon with a practice approach one standard deviation above a surgeon with the average CPM rate (independent of age, diagnosis date, BRCA status and risk of 2nd primary). One quarter (25%) of the surgeon influence was explained by attending attitudes about initial recommendations for surgery and responses to patient requests for CPM. The estimated rate of CPM was 34% for surgeons who least favored initial breast conservation and were least reluctant to perform CPM vs 4% for surgeons who most favored initial breast conservation and were most reluctant to perform CPM. ; Conclusion and Relevance ; Attending surgeons exert strong influence on the likelihood receipt of CPM after diagnosis of breast cancer. Variations in surgeon attitudes about recommendation for surgery and response to patients request for CPM explain a substantial amount of this influence.
  More +
• Subjects:
  • Article
  • Attitude of Health Personnel
  • Breast Neoplasms
  • Directive Counseling
  • Female
  • Georgia
  • Humans
  • Los Angeles
  • Male
  • Mastectomy
  More +
• Source:
  JAMA Surg. 153(1):29-36
• Pubmed ID:
  28903158
• Pubmed Central ID:
  PMC5833615
• Document Type:
  Journal Article
• Funding:
  HHSN261201000140C/CA/NCI NIH HHSUnited States/ ; HHSN261201000035C/CA/NCI NIH HHSUnited States/ ; P30 CA008748/CA/NCI NIH HHSUnited States/ ; HHSN261201000035I/CA/NCI NIH HHSUnited States/ ; HHSN261201300015C/CA/NCI NIH HHSUnited States/ ; HHSN261201000034C/CA/NCI NIH HHSUnited States/ ; U58 DP003862/DP/NCCDPHP CDC HHSUnited States/ ; P01 CA163233/CA/NCI NIH HHSUnited States/ ; U58 DP003875/DP/NCCDPHP CDC HHSUnited States/
• Volume:
  153
• Issue:
  1
• Download URL:
  https://stacks.cdc.gov/view/cdc/53383/cdc_53383_DS1.pdf
• File Type:
  [PDF - 982.42 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:927d1383175eab1b7b1718621241a3db8e6202ac77412912cd29833b85c7f4fa