Volumes of cancer surgery for breast, colorectal and ovarian cancer 1992-97: is there evidence of increasing sub-specialisation by surgeons?

The 'Calman-Hine Report' (1995) recommended that cancer surgery should be l imited to 'high-volume' consultants. Through an analysis of 5 years of Hosp ital Episode Statistics for the West Midlands region (1992-1997), we have i nvestigated whether there is evidence of increasing numbers of patients wit h breast. colorectal or ovarian cancer being treated by high throughput, i. e. sub-specialist surgeons, who carry out more than a threshold level of pr imary cancer resections annually. The proportion of cases treated by the hi gh-volume breast, colorectal and ovarian cancer surgeons increased annually during the 5 years. The absolute number of consultant firms who undertook breast cancer resections reduced during the 5 years; but the number doing c olorectal and ovarian surgery increased. Throughout the 5 years, half of th e ovarian cancer resections were carried out by consultant firms who did ve ry few procedures - less than 5 of these procedures annually. The relativel y high case-load, the elective nature of breast cancer surgery and an early policy change have undoubtedly facilitated the move towards sub-specializa tion. The weaker trends for colorectal and ovarian cancer surgery suggest c ontinued monitoring is required to ensure that there is a reduction in the proportion of people treated by surgeons who undertake few cancer resection s annually. (C) 2001 Cancer Research Campaign.