[MOL] BREAST CANCER SERIES ! OF 4.... [01041] Medicine On Line

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Once you have been told that you do have breast cancer or might have breast cancer, you will be referred to a surgeon. There are many doctors who perform breast cancer surgery but not that many who are truly breast surgeons.

Breast surgery, whether it be in the form of a lumpectomy or mastectomy has historically been thought to be a "simple" surgical procedure to do. Well, if it is your breast it might not sound so simple.

There are many general surgeons who perform breast cancer surgery. They might do one case a year or perhaps as many as twenty. You want to go and be seen by a surgeon who IS a breast surgeon... who has chosen this to be his or her surgical specialty and who does a lot of breast surgeries every year. These are physicians with the surgical experience you are seeking. They have chosen this as their field of specialty and will be probably more up to date on the latest surgical techniques.

High volume surgeons tend to have better results and are more attuned to subtle differences in individual cases. Seek out a physician who does fifty or more breast cancer operations a year. (For example in Maryland during 1996, there were 287 surgeons who only performed one inpatient breast cancer surgery. There were an additional 94 physicians who only did two such operations. Of all the women having breast cancer surgery in Maryland during this period, only 8.6 % of them were treated by a surgeon who had done more than 50 breast surgical procedures that year. Additionally, of the 647 surgeons who did inpatient breast cancer surgery, only 1.5% of them had done more than 30 inpatient operations in 1996.)

You can find out this kind of information from several sources: call the hospital where the doctor is in practice and ask for information about case volume. His or her office should be more than willing to provide this type of information to you. Call your state board of quality assurance and ask for information on file about the physician you are considering seeing. They will also have information about any malpractice cases he has had and other quality of care complaints that have been filed against him. This information isn't published data but is available by making a simple call. (Keep in mind however that physicians who treat large numbers of women with breast cancer may have some information on file where as a physician who only treats a handful of patients a year may have nothing on file.)

You also want to know about the credentialling of the physicians you choose; this includes your breast surgeon, medical oncologist, radiation oncologist, radiologist and others involved in your care. Your wisest choice is to choose a physician board certified by The American Board of Surgery as your breast surgeon. He or she had to be trained in a recognized approved training program and pass rigorous exams after training. The American Board of Medical Specialists can be reached by calling 1-847-491-9091 or by going to their web site which is: www.abms.org. They can provide you information regarding who in your region meets this criteria. Surgeons of this specialty also frequently are members of the American College of Surgeons. This distinction comes only after having become board certified and practicing in a community for greater than 3 years. These surgeons are considered by their peers to be above average in the care of surgical patients.

Finally, most true breast surgeons are also members of The Society of Surgical Oncology. This society only accepts as members those with substantially greater training and/or experience in the management of cancer. Most of the latest developments in the surgical management of breast cancer are presented at annual educational meetings of this society. The standards for the surgical care of breast cancer patients are developed by the American College of Surgeons and The Society of Surgical Oncology jointly. Not all breast surgeons do breast cancer surgeries 100% of the time. But consider this - some full time breast surgeons do surgery on only 25-30 new cancer cases each year but others who do only 75% breast surgery treat over 200 new cases a year!

The same criteria applies for each other specialty physicians who will be providing your care. They should be board certified for their specialty with a subspecialty in breast cancer. There are lots of physicians for example who are medical oncologists and provide treatment to cancer patients. You want to receive your care however from someone whose specialty or major interest is "breast cancer