SURGEON VARIABILITY IN TREATING NONPALPABLE BREAST-CANCER - SURGICAL ONCOLOGY AS A VALUE-ADDED SPECIALTY

Background: Several studies have demonstrated a relatively low rate of breast conservation surgery (BCS) in the United States. Few have anal yzed the impact of individual surgeon variability on the outcome of th e procedure, and none have contrasted surgical oncologists versus gene ral surgeons in the treatment of nonpalpable breast cancer. Methods: A blinded review was done of 409 excisions for nonpalpable breast cance r performed by 11 board-certified general surgeons (GS, n = 221) and o ne surgical oncologist (SO, n = 185) in a teaching institution. We com pared surgical margins, need for reexcision, and breast conservation r ates. Results: Although there were no significant differences in patie nt and tumor characteristics, there were surprising differences betwee n the CS and SO, especially related to surgical margins and final trea tment. The SO has a significantly higher rate of frozen section compar ed to GS (81% vs. 64%, P < 0.01) and a lower rate of positive margin a t the time of original biopsy (25% vs. 41%, P < 0.01). These differenc es translated into lower necessity for reexcision of tumor (18% vs. 48 %, P < 0.01) and higher rate of BCS (88% vs. 70%, P < 0.01). Conclusio n: This study demonstrates marked difference among trained general sur geons. The additional experience of a surgical oncologist is valuable, because fewer positive margins lead to a higher likelihood of breast preservation and decreased costs related to fewer additional operative procedures.