Breast cancer surgeons prefer to go it alone

The standard for delivering the best quality of care to breast cancer patients calls for surgeons to consult with other specialists and to provide resources and education to help patients decide their course of treatment.

“But surgeons in the community are reporting relatively little of that,” says Dr. Steven J. Katz, a professor of internal medicine at the University of Michigan Medical School.

Katz and colleagues at the UM Comprehensive Cancer Center asked more than 300 surgeons who treat breast cancer patients in the Detroit and Los Angeles areas about how they conduct their practices. The questions gauged whether the surgeons:

• consult with medical oncologists, radiation oncologists, and plastic surgeons;

• collect biopsy specimens or mammograms;

• offer patient education videos or presentations; and

• connect patients with peers, for example, through support groups.

Fewer than one-third reported that they routinely discuss patients’ treatment plans with medical or radiation oncologists, according to Katz, who also serves as a professor of health management and policy at the UM School of Public Health. Just 13% reported routinely consulting with a plastic surgeon. About one-third of surgeons said their patients typically participate in patient decision-support activities, such as viewing a video or web-based materials or attending peer support programs.

“Either doctors are not convinced these elements matter or there are logistical constraints in terms of building these standards into their practices,” he said.

The implications for healthcare in the U.S. are substantial. Nearly 200,000 Americans are diagnosed annually with breast cancer each year, according to the American Cancer Society. More than 40,000 die from the disease.

In attending to the needs of this patient population, however, not all surgeons are so cavalier with best practices. Katz noticed that surgeons who treated mostly breast cancer patients were more likely than others to report that they performed services reflecting best practices.

“These results suggest patients might find a more integrated practice among surgeons with higher volume, but we don’t know whether that matters with regards to patient decision-making, quality of life, and satisfaction,” Katz said.