CDC STACKS serves as an archival repository of CDC-published products including scientific findings, journal articles, guidelines, recommendations, or other public health information authored or co-authored by CDC or funded partners.
As a repository, CDC STACKS retains documents in their original published format to ensure public access to scientific information.
i
Surgeon influence on receipt of contralateral prophylactic mastectomy: Does it matter who you see for breast cancer surgery?
-
1 2018
-
-
Source: JAMA Surg. 153(1):29-36
[PDF-982.42 KB]
Details:
-
Alternative Title:JAMA Surg
-
Personal Author:
-
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.
-
Subjects:
-
Source:
-
Pubmed ID:28903158
-
Pubmed Central ID:PMC5833615
-
Document Type:
-
Funding:
-
Volume:153
-
Issue:1
-
Collection(s):
-
Main Document Checksum:
-
Download URL:
-
File Type:
