Surgeon variability in treating nonpalpable breast cancer: surgical oncology as a value-added specialty

Several studies have demonstrated a relatively low rate of breast conservation surgery (BCS) in the United States. Few have analyzed the impact of individual surgeon variability on the outcome of the procedure, and none have contrasted surgical oncologists versus general surgeons in the treatment of nonpalpable breast cancer.

A blinded review was done of 409 excisions for nonpalpable breast cancer performed by 11 board-certified general surgeons (GS, n = 221) and one surgical oncologist (SO, n = 185) in a teaching institution. We compared surgical margins, need for reexcision, and breast conservation rates.

Although there were no significant differences in patient and tumor characteristics, there were surprising differences between the GS and SO, especially related to surgical margins and final treatment. The SO has a significantly higher rate of frozen section compared to GS (81% vs. 64%, P < 0.01) and a lower rate of positive margin at the time of original biopsy (25% vs. 41%, P < 0.01). These differences 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).

This study demonstrates marked differences among trained general surgeons. 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.