How Familiar Are You with Your Breast Surgeon's Credentials and Training?

This isn't just idle curiosity on my part--it turns out that your surgeon's real-life experience and expertise can actually be a life-and-death matter.

In other words, your choice of a breast surgeon can't be based on some TV commercial starring a "kind looking" physician, or on a neighbor's semi-enthusiastic recommendation that they "liked" Dr. So-and-So.

No, in order to find a breast surgeon who is a skilled lifesaver, you're going to have to seek out and evaluate the information that's available about his or her medical expertise. Here's why.

Recurrence rates of breast cancer vary widely

It turns out that the chances that a surgeon's patients will experience a recurrence of cancer in the same breast (a "local recurrence") vary shockingly. Some surgeons see recurrence in only 15 percent of their patients, while others have recurrence rates as high as 35 percent. Ladies, 15 percent to 35 percent is an awfully big point spread when making decisions about who will help ensure you become cancer free and stay cancer free.

This means that a woman's risk for local recurrence depends in part on which surgeon she chooses. Take ductal carcinoma in situ (DCIS) as an example. This type of cancer, also known as noninvasive breast cancer, is typically treated with either

• ·         lumpectomy (also known as breast-conserving surgery) or
• ·         mastectomy

Which surgeons are best at avoiding recurrences?

And whether or not a woman remains cancer free also depends in part on which of these treatments her surgeon decides to perform.

All of which leads one to hope that the surgeon bases this decision on a great deal of hands-on experience and a solid theoretical knowledge of when each of these 2 procedures will bring about optimal results, right? Well, I hate to say it, but many times this hope is not borne out by the facts.

Here's why I say this: The January 3, 2011, issue of The Journal of the National Cancer Institute contains a study by the RAND corporation that compared the effectiveness of various strategies used between 1983 and 2000 to treat DCIS. Based on this research, the 2 factors that best predicted that a breast cancer would not recur were:

• if, under the microscope, all 6 margins of the surgical specimen (from either a lumpectomy or mastectomy) are determined to have no cancer cells or abnormal cells at the edges--a condition referred to as "clear margins." 
• if the woman received radiation therapy following lumpectomy (breast-conserving) surgery

Many surgeons come up short

Sad to say, the researchers found that many of the surgeons in the study did not know that these 2 factors were lifesavers. Some of the surgeons did not even know when a lumpectomy could be safely carried out while still providing the patient with the same survival rate as a mastectomy, versus when the more radical mastectomy absolutely had to be done.

Remember up above, when I said that breast-cancer surgeons differed widely as to how many of their patients had local recurrences--from 15 percent to 35 percent? Well, the Rand study found that most of the surgeons with the highest recurrence rates (up to 35 percent) either didn't pay attention to the microscopic margins of the tumors they removed, or didn't know that giving radiation after lumpectomy was absolutely essential, or both.

The bottom line

This report from the Rand Corporation supports previous studies that emphasize, when one is facing breast cancer surgery, the importance of

• choosing someone who is a breast surgical oncologist. Please repeat after me: a breast surgical oncologist
• not choosing a general surgeon who ordinarily spends the day taking out gallbladders or doing hernia repairs

In making this last point, I in no way mean to belittle general surgeons, who perform vital, lifesaving operations daily. I am just emphasizing that when you need your hernia repaired, go to a general surgeon whose expertise is hernia repairs. But when you have breast cancer, seek out a surgeon who has completed a fellowship in breast surgical oncology and now specializes in this disease.