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CMAJ • July 24, 2001; 165 (2)
© 2001 Canadian Medical Association or its licensors

Letters
Correspondance

Do women treated for breast cancer at teaching hospitals really fare better?

Philip Barron

Surgeon Ottawa Hospital — Civic Campus Ottawa, Ont.

In many jurisdictions there is increasing pressure on oncology services to specialize. Ruhee Chaudhry and colleagues provide evidence that survival following breast cancer treatments is better when care is provided at teaching hospitals rather than at community hospitals.1 This is not supported by Golledge and colleagues, who found that specialization of breast cancer treatments, not the teaching status of the treating institution, affected outcomes.2 From 1990 to 1992, care of breast cancer patients in a community hospital in England was managed by all 5 local surgeons. From 1993 onward, care of breast cancer patients was concentrated in the hands of 2 of those surgeons. Disease-free survival improved and the local recurrence rate decreased following specialization of services. The results were attributed to an increase in axillary dissection and more frequent use of tamoxifen and chemotherapy. Gillis and Hole reported similar post-specialization results in the west of Scotland.3 Although the teaching status of the treating hospitals was not reported in this study, it is likely that specialization occurred in both teaching and nonteaching hospitals, given the demographics of this region.

The teaching status of the initial treating hospital is unlikely to serve as a useful proxy for surgical specialization and use of adjuvant therapies. Breast cancer management is a multidisciplinary process; whether the initial surgery is done in Ottawa or Owen Sound is probably not relevant.

References

  1. Chaudhry R, Goel V, Sawka C. Breast cancer survival by teaching status of the initial treating hospital. CMAJ 2001;164(2):183-8.[Abstract/Free Full Text]
  2. Golledge J, Wiggins JE, Callam MJ. Effect of surgical subspecialization on breast cancer outcome. Br J Surg 2000;87:1420-5.[Medline]
  3. Gillis CR, Hole DJ. Survival outcome of care by specialist surgeons in breast cancer: a study of 3786 patients in the West of Scotland. BMJ 1996;312:145-8.[Abstract/Free Full Text]




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