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Study Finds Benefits for Breast Cancer Patients Cared for by Teams of Doctors (dateline April 24, 2001)

Breast cancer patients who are diagnosed and treated by teams of physicians may receive better care than patients who are treated by physicians who do not usually consult colleagues in related specialties, according to a new study. For example, at "comprehensive cancer centers," radiologists, pathologists, oncologists, surgeons, radiation therapists, and reconstructive/plastics surgeons often work together when caring for patients. Many community physicians who do not work in cancer centers still collaborate with other physicians about individual patients. This team approach, according to researchers, leads to more thorough evaluations and often more favorable treatment options for patients.

In an effort to show that "team treatment" is often more valuable than treatment by physicians not working in concert, a team of physicians at the University of Pennsylvania Cancer Center reviewed the medical records of 75 women with breast abnormalities who were previously diagnosed and treated by various outside physicians before coming to the Penn Center for second opinions. Each patient’s case was reviewed by a medical oncologist, a surgical oncologist, a radiation oncologist, a pathologist, a diagnostic radiologist, and when necessary, a plastic surgeon. The physicians took the patient’s medical histories, performed physical examinations, and reviewed relevant mammograms, pathology slides, and medical records.

Researcher Lynne Schuchter, MD, a medical oncologist at the University of Pennsylvania, and her colleagues found that in the vast majority of patients, the team of physicians at the cancer center made the same diagnoses as the outside physicians. However, the cancer team was more likely to order further breast imaging before recommending a breast biopsy.

When it came to treatment recommendations, the researchers saw a significant difference in recommendations between the Pennsylvania Cancer Center team and the various outside physicians. The cancer team’s treatment recommendations differed from the outside physicians in 43% of the cases (32 of 75). For many of these patients, the cancer team recommended breast-conserving surgery (lumpectomy) instead of mastectomy, which was recommended more by the outside physicians who did not collaborate with colleagues in related specialties.

According to Dr. Schuchter, breast-conserving surgery is a viable treatment option for most patients with Stage I or Stage II breast cancers. Even though the National Cancer Institute has been recommending for the past ten years that women with early stage breast cancers be given this option, Dr. Schuchter said that the recommendation has been slow to catch on with some community physicians. While the likelihood that breast cancer will recur is higher with breast-conserving surgery than with mastectomy, studies have shown that both surgeries are effective for women with early stage breast cancer. Furthermore, the survival rate is the same regardless whether breast-conserving surgery (lumpectomy) or mastectomy is performed.

In a previous study presented at the annual meeting of the Radiological Society of North America (RSNA), Lillian Rinker, MD and her colleagues from the Methodist Healthcare-Central Hospital in Memphis, Tennessee found that the type of breast cancer surgery a woman receives depends largely on her surgeon’s choice. According to Dr. Rinker, many women are afraid that lumpectomy is not as effective as mastectomy, and when they communicate that fear to their surgeon, they get the impression from the surgeon that mastectomy is a safer option, which may not be the case.

While the University of Pennsylvania study shows that the care women received at their cancer center offered advantages over that of various outside physicians, it is not always possible for women to be treated at comprehensive cancer centers. However, many community physicians collaborate with colleagues in related specialties, especially when a case is not straightforward. In fact, many community physicians serve on cancer boards, which meet frequently to discuss individual cases. Other physicians are part of "virtual centers," in which physicians of related specialties in different locations work together to provide team care to patients.

Patients should feel free ask their physicians whether they collaborate with colleagues on a regular basis, especially before making treatment recommendations. It is also important that women learn all they can about their cancer and come to their physicians with questions about their treatment choices.

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