Mary Ann Gilligan ^1*, Joan Neuner ¹, Xu Zhang ², Rodney Sparapani ¹, Purushottam W. Laud ¹, Ann B. Nattinger ¹

¹ Medical College of Wisconsin
² Georgia State University

^* To whom correspondence should be addressed. E-mail: gilligan{at}mcw.edu.

	Abstract

Objectives. We examined the association between number of breast cancer operations performed in a hospital (hospital volume) and all-cause and breast cancer-specific mortality using a national database and state-of-the-art statistical methods. Methods. In a retrospective cohort study, we linked Surveillance, Epidemiology, and End Results tumor registry data with Medicare claims data. The cohort included 11 225 Medicare patients who had undergone surgery for early-stage breast cancer from 1994 to 1996 in 457 different hospitals. Primary outcomes were all-cause and breast cancer-specific survival rates at a mean follow-up time of 62.5 months. Results. In comparison with treatment in a low-volume hospital, treatment in a high-volume hospital was associated with hazard ratios of 0.83 (95% confidence interval [CI]=0.75, 0.92) for all-cause mortality and 0.80 (CI=0.66, 0.97) for breast cancer-specific mortality. Conclusions. An association between the volume of breast cancer operations performed in a hospital and 5-year survival rates was observed for both all-cause and breast cancer-specific mortality. Further work investigating the aspects of hospital volume that contribute to increased survival is warranted.

Key Words: Cancer, Health Care Facilities/Services, Health Policy, Quality of Care

This article has been cited by other articles:

				C. Hery, J. Ferlay, M. Boniol, and P. Autier Quantification of changes in breast cancer incidence and mortality since 1990 in 35 countries with Caucasian-majority populations Ann. Onc., June 1, 2008; 19(6): 1187 - 1194. [Abstract] [Full Text] [PDF]

				A. B. Nattinger, P. W. Laud, R. A. Sparapani, X. Zhang, J. M. Neuner, and M. A. Gilligan Exploring the Surgeon Volume Outcome Relationship Among Women With Breast Cancer Arch Intern Med, October 8, 2007; 167(18): 1958 - 1963. [Abstract] [Full Text] [PDF]