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Published on: June 1, 2019
Geographic variation in sentinel node adaptation by practicing surgeons in Oregon
Jennifer R Garreau1, Joanne Nelson, David Cook
1Department of Surgery, Oregon Health & Science University, Portland, OR, USA. garreauj@ohsu.edu
Background:
The sentinel node biopsy (SNB) technique is an important tool in the diagnosis and treatment of breast cancer and melanoma. However, surgeons in Oregon have not universally adopted its use.
Methods:
Mailed questionnaire.
Results:
The response rate was 32%. Seventy-four (76%) of the surgical respondents perform routine SNB; 49% completed courses, and 32% learned the technique in residency. Sixty-one (89%) performed axillary dissection with their initial cases. It took 21 of 40 (52%) surgeons greater than a year to accrue 20 cases. Of 23 surgeons (24%) not performing SNB, 89% believed it was an important skill to obtain, and 70% thought they would benefit from proctoring opportunities. Six (26%) did not have technological support at their hospital. Surgeons at hospitals with less than 50 beds (P = .001) and at rural hospitals (P = .003) were less likely to perform SNB.
Conclusion:
The majority of urban general surgeons in Oregon use SNB in their practice. However, the incorporation of SNB for surgeons practicing in smaller hospitals and rural settings is less frequent than in the urban environment. As SNB becomes the standard of care, we need to overcome these barriers so that patients can have access to this procedure in their own communities.
Insights
Sentinel node biopsy (SNB) is widely used by urban surgeons in Oregon, but adoption is lower in rural and smaller hospitals. Overcoming barriers is crucial for equitable patient access to this cancer diagnostic technique.
Area of Science:
- Oncology
- Surgical Oncology
- Medical Practice Analysis
Background:
- Sentinel node biopsy (SNB) is a critical technique for diagnosing and treating breast cancer and melanoma.
- Widespread adoption of SNB by surgeons in Oregon has not yet been achieved.
Purpose of the Study:
- To assess the current adoption rates of SNB among surgeons in Oregon.
- To identify barriers to SNB implementation in surgical practices within the state.
Main Methods:
- A mailed questionnaire was distributed to assess SNB utilization.
- Data were collected on surgeons' training, practice patterns, and perceived barriers.
Main Results:
- 76% of responding surgeons routinely perform SNB, with most learning it through residency or continuing education.
- Barriers include lack of technological support and hospital size/location; surgeons in smaller, rural hospitals are less likely to perform SNB.
- Many surgeons not performing SNB recognize its importance and express interest in proctoring.
Conclusions:
- While most urban Oregon surgeons utilize SNB, adoption is significantly lower in rural and smaller hospital settings.
- Barriers to SNB implementation must be addressed to ensure equitable patient access to this standard of care.
- Targeted support and training may be necessary to increase SNB use in underserved areas.
