In Treatment, Practice Makes More Perfect

Women with breast cancer are much better off when they are seen at hospitals that do brisk business in such treatment. Patients at hospitals treating fewer than 25 breast cancer patients per year had a 20% lower survival rate after five years than patients at hospitals handling larger numbers of breast-cancer patients, researchers said.

Dr. Monica Morrow, an oncologist at Northwestern University Medical School in Chicago, analyzed data from 1,304 institutions on 175,879 women with breast cancer. She found that 509 of the hospitals, or about 39%, treated fewer than 25 breast-cancer patients a year, while 12% treated more than 100 patients a year. Patients at the high-volume hospitals were clearly doing better.

"What the study does not say is that physicians in large hospitals are better than physicians in small hospitals," Morrow said. The difference, she believes, is in the entire "system of care" at bigger hospitals: Better mammography may catch tumors earlier, the pathologists' analysis of tumors might be more thorough, and care is more likely to be provided by a team representing multiple specialties. The study follows earlier reports that busy hospitals have better outcomes with high-risk cancer surgery and chemotherapy.

Next, Morrow hopes to determine exactly which of these factors account for the survival differences. Meanwhile, she says, the 20% differential is important enough that patients at low-volume hospitals should seek a second opinion at a busier hospital.

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