Does Center Volume Correlate with Survival from Breast Cancer?

Abstract

Key WordsBreast cancer · Caseload · Survival · Specialization Summary With its high incidence and long history of patient advocacy, breast cancer has generated the most concern about the quality of its care and the volume-outcome relationship. In breast cancer surgery, the risk of perioperative morbidity or mortality is low, but surgery is only one single piece in the mosaic of multidisciplinary care that eventually determines survival. Only a limited number of articles is available investigating the relationship between case volume of physicians and hospitals and specialization of surgeons and survival. In summary, there is evidence to support the hypothesis that specialization, research interest, and caseload of physicians and hospitals is positively correlated with providing state-of-the-art care and with survival. However, it is less clear what impact might be attributed to the surgical routine gained with increasing number of procedures compared to the deeper insight into the biology of breast cancer that comes with specialization in oncology and the weight of the multidisciplinary setting that is more easily established and maintained with a higher caseload.

Survival from breast cancer: an analysis of Australian data by surgeon case load, treatment centre location, and health insurance status

“…53 The association between higher surgeon case load and higher survival found both in the unadjusted analysis and the analysis adjusted for age and clinical risk factors, accords with results of most studies in North America, Europe, Asia and Western Australia. 16,[28][29][30][31][32][33][34][35][36][37][38][39][40] The difference mostly occurred between 21-100 cases per annum and lower case loads, with little difference observed between the 21-100 and higher case loads. Other studies have shown a progressive association between higher case loads and survival, interpreted by some researchers as strengthening evidence of a causal relationship.…”

“…This was similar to classifications in some other studies, although classification categories have not been consistent across studies. [28][29][30][31][32][33][34][35][36][37][38][39][40][41] Treatment centre location was categorised as major city, inner regional or more remote, using the Australian Standard Geographical Classification. 44 These categories are based on Census Collection Districts (CDs) categorised using the Accessibility/Remoteness Index for Australia (ARIA), which is a measure of the remoteness of a location from the services provided by large towns or cities.…”

“…16,[19][20][21][22][23][24][25][26][27] Often these were studies of other cancers, although higher survivals from breast cancer have been linked to higher case loads in North America, Europe, Asia and Western Australia. [28][29][30][31][32][33][34][35][36][37][38][39][40] Results have generally been interpreted as reflecting higher skill development from managing higher case loads, although this interpretation has been questioned and alternative explanations suggested, including accompanying differences in degree of specialisation, access to multidisciplinary conferencing, and availability of specialist adjunctive services. 22,33,41 In the USA, lack of private health insurance can be a barrier to appropriate breast and other cancer care for optimising survival.…”

“…[28][29][30][31][32][33][34][35][36][37][38][39][40] Results have generally been interpreted as reflecting higher skill development from managing higher case loads, although this interpretation has been questioned and alternative explanations suggested, including accompanying differences in degree of specialisation, access to multidisciplinary conferencing, and availability of specialist adjunctive services. 22,33,41 In the USA, lack of private health insurance can be a barrier to appropriate breast and other cancer care for optimising survival. 18,42 The extent to which this would apply in Australia is uncertain, given universal public health insurance, although differences in outcomes might still apply due to differences in socioeconomic and clinical risk factors or access to care.…”

Certify it! Breast Cancer Units in Europe

“…The authors Scharl and Göhring discuss the correlation between minimal numbers and course of disease [4]. For the criterion of minimal numbers, it is important to know which parameters are being used.…”