Nobody knows – yet – whether a woman’s chances of survival will be better if she takes the time to pick a breast surgeon carefully. But a new study of nearly 2,000 patients, published in January in the Journal of Clinical Oncology, does show that women who choose a surgeon carefully, as opposed to those who merely accept a referral from their health plans, were more likely to be treated by a surgeon who does a high volume of breast surgeries and to be cared for in a hospital with a comprehensive cancer program approved by the American College of Surgeons or a National Cancer Institute-designated cancer center.
Many women, especially if they are poorer or less educated, simply see whichever surgeon their plan suggests, regardless of whether that surgeon specializes in breast surgery or does a bit of everything, said Dr. Steven Katz, the study’s lead author and a professor of medicine and health management and policy at the University of Michigan.
“We found that women who were involved in the selection of a surgeon were more likely to see an experienced surgeon in a more comprehensive center,” said Katz. In general, the more a surgeon specializes, the better the outcome.
Dr. Michele Gadd a breast cancer surgeon at Massachusetts General Hospital, used to perform different kinds of surgery but concluded she “could only do one well” and now does exclusively breast surgery. She suggested that women looking for a breast cancer surgeon ask whether the doctor specializes in breast surgery, how many mastectomies (removal of the whole breast) the surgeon does in a month – ideally, the answer is 5 or more, and how many lumpectomies (removal of just the cancerous lump) they do – ideally 15 or so per month.
In addition, she suggested that women ask the surgeon about recurrence rates, “skin-sparing” mastectomies (in which the breast is removed, but the skin is saved for a better cosmetic result), nipple-sparing procedures, “sentinel node” biopsies (in which just one or a few lymph nodes are removed, not all the nodes in the armpit) and about “neo-adjuvant therapy,” in which a woman gets chemotherapy before surgery.
As for whether choosing a surgeon carefully improves outcomes, Katz said his team is about to study that.