Medical Design and Outsourcing

  • Home
  • Medical Device Business
    • Mergers & Acquisitions
    • Financial
    • Regulatory
  • Applications
    • Cardiovascular
    • Devices
    • Imaging
    • Implantables
    • Medical Equipment
    • Orthopedic
    • Surgical
  • Technologies
    • Contract Manufacturing
    • Components
    • Electronics
    • Extrusions
    • Materials
    • Motion Control
    • Prototyping
    • Pumps
    • Tubing
  • Med Tech Resources
    • DeviceTalks Tuesdays
    • Digital Editions
    • eBooks
    • Manufacturer Search
    • Medical Device Handbook
    • MedTech 100 Index
    • Podcasts
    • Print Subscription
    • The Big 100
    • Webinars / Digital Events
    • Whitepapers
    • Video
  • 2022 Leadership in MedTech
    • 2022 Leadership Voting!
    • 2021 Winners
    • 2020 Winners
  • Women in Medtech

Breast Cancer Recurrence May Depend On Surgeon

January 4, 2011 By AxoGen, Inc.

Ductal carcinoma in situ (DCIS), or non-invasive breast cancer, is typically treated with either breast-conserving surgery—with or without follow-up radiation—or mastectomy. The treatment choice depends on clinical factors, the treating surgeon, and patient preferences, with long-term health outcomes (disease-free survival) depending on the treatments received. According to a study published in The Journal of the National Cancer Institute , however, health outcomes are also associated with the treating surgeon.

To determine the comparative effectiveness of treatment strategies, Andrew W. Dick, Ph.D., of the RAND Corporation, and colleagues, conducted a retrospective study of women diagnosed with DCIS between 1985 and 2000 with as many as 18 years of follow-up. The researchers collected extensive data on the patients, including the rate of ipsilateral recurrence, or recurrent breast cancer in the same breast; whether the women had been treated with mastectomy or breast conserving surgery—with or without radiation therapy; and their margin status (margin of tissue surrounding their resected tumors). They defined margins as positive (in which cancer cells extend to the edge of the resected tissue), negative (cancer cells are more than two millimeters away from the edge of the tissue), or close (in which cancer cells are present within two millimeters of the edge).

According to the researchers, the two most important determinants of recurrent breast cancer are the tumor margins and whether or not the women have received radiation therapy following breast-conserving surgery. “BCS in the absence of radiation therapy resulted in substantially lower ipsilateral event-free survival than either BCS followed by radiation therapy or mastectomy,” the authors write, adding, “Regardless of treatments, positive or close margins following the last surgical treatment substantially compromised ipsilateral event-free survival.” Both of these important determinants of outcomes, however, varied markedly by the treating surgeon.

The authors write that the wide variability in treatment by surgeons may reflect differences in surgeons’ knowledge, attitudes, and beliefs, especially given the lack of consensus on what constitutes a negative margin. “Lack of knowledge about the importance of margins, and differences in beliefs about the role of radiation therapy in local control, together with differences in physician-patient communication during the decision-making process could explain the substantial variation in the acceptance of positive margins and the determination not to proceed to mastectomy,” the authors write.

Nevertheless, they estimate that with modest reductions in variation by surgeon, based only on changes among those surgeons with low rates of radiation therapy and high rates of positive or close margins, ipsilateral 5 and 10-year event rates could be reduced by 15 to 30 percent. In an accompanying editorial, Beth A. Virnig, Ph.D., and Todd M. Tuttle, M.D., of the University of Minnesota, write that the study poses a perplexing question; “How should women select a provider knowing that up to 35 percent of the variation in outcomes is based on their choice of physician, but that there are no actionable characteristics that can be taken into account?”

They suggest one solution could be publishing the scores for all physicians performing breast cancer surgery in a particular area. In any case, the variability in surgeons’ treatment choice provides a potential opportunity to improve or standardize DCIS care. They write, “The challenge is then for the professional community to identify factors that are associated with the currently unexplained physician variability and to use that information to promote identification of high-quality providers or quality improvement activities.”

Related Articles Read More >

Avail Medsystems
How Avail Medsystems seeks to create a connected OR experience
Engineer inspecting artificial hip joint parts in quality control department in orthopaedic factory
Deburring and finishing for beautiful, functional medical devices
FDA logo
FDA seeking innovations to move beyond heater-cooler device problems
Logos of Creo Medical and Intuitive
Creo Medical inks collaboration agreement with Intuitive

DeviceTalks Weekly.

June 24, 2022
How innovative design, commercial strategy is building Cala Trio’s bioelectronic medicine market
See More >

MDO Digital Edition

Digital Edition

Subscribe to Medical Design & Outsourcing. Bookmark, share and interact with the leading medical design engineering magazine today.

MEDTECH 100 INDEX

Medtech 100 logo
Market Summary > Current Price
The MedTech 100 is a financial index calculated using the BIG100 companies covered in Medical Design and Outsourcing.
DeviceTalks

DeviceTalks is a conversation among medical technology leaders. It's events, podcasts, webinars and one-on-one exchanges of ideas & insights.

DeviceTalks

New MedTech Resource

Medical Tubing

Enewsletter Subscriptions

Enewsletter Subscriptions

MassDevice

Mass Device

The Medical Device Business Journal. MassDevice is the leading medical device news business journal telling the stories of the devices that save lives.

Visit Website
MDO ad
Medical Design and Outsourcing
  • MassDevice
  • DeviceTalks
  • MedTech 100 Index
  • Medical Tubing + Extrusion
  • Drug Delivery Business News
  • Drug Discovery & Development
  • Pharmaceutical Processing World
  • R&D World
  • About Us/Contact
  • Advertise With Us
  • Subscribe to Print Magazine
  • Subscribe to E-newsletter
  • Attend our Monthly Webinars
  • Listen to our Weekly Podcasts
  • Join our DeviceTalks Tuesdays Discussion

Copyright © 2022 WTWH Media, LLC. All Rights Reserved. The material on this site may not be reproduced, distributed, transmitted, cached or otherwise used, except with the prior written permission of WTWH Media LLC. Site Map | Privacy Policy | RSS

Search Medical Design & Outsourcing

  • Home
  • Medical Device Business
    • Mergers & Acquisitions
    • Financial
    • Regulatory
  • Applications
    • Cardiovascular
    • Devices
    • Imaging
    • Implantables
    • Medical Equipment
    • Orthopedic
    • Surgical
  • Technologies
    • Contract Manufacturing
    • Components
    • Electronics
    • Extrusions
    • Materials
    • Motion Control
    • Prototyping
    • Pumps
    • Tubing
  • Med Tech Resources
    • DeviceTalks Tuesdays
    • Digital Editions
    • eBooks
    • Manufacturer Search
    • Medical Device Handbook
    • MedTech 100 Index
    • Podcasts
    • Print Subscription
    • The Big 100
    • Webinars / Digital Events
    • Whitepapers
    • Video
  • 2022 Leadership in MedTech
    • 2022 Leadership Voting!
    • 2021 Winners
    • 2020 Winners
  • Women in Medtech