Breast cancer patients: Your doctor really matters

How doctors choose to treat their breast cancer patients may play a larger role in whether the cancer returns than experts have believed.

Beth Virnig

That’s according to a RAND Corp. study that looked at 994 women with pre-invasive breast cancer. Researchers found significant treatment variations from surgeon to surgeon that may account for up to 30 percent of cancer recurrences.

“The study found that not all surgeons are equal,” says SPH professor Beth Virnig, who co-wrote an editorial to accompany findings in the Journal of the National Cancer Institute.

“For instance, in spite of the finding that mastectomy has lower risk of recurrence, a woman still might be better off having a more skilled surgeon doing breastconserving surgery plus radiation than a less-skilled surgeon doing a mastectomy.” That means women need to consider not just what treatment they get, but who gives them the treatment.

However, the study does not provide guidance on finding good surgeons. One solution, Virnig says in her editorial, is to develop a scoring system for breast cancer surgeons. But she acknowledges this may not be feasible.

Meanwhile, she suggests women get their doctors’ views on radiation therapy after breast-conserving surgery and the importance of negative margins, both of which are associated with a lower risk of recurrence.

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