Dissertation Abstract

Do Surgeons Influence the Treatment Rates for T1 Breast Cancer Patients at the Local Level of Health Care?

Breast cancer is the leading cause of death in women ages 35-54. A research consensus has been published stating that breast conserving therapy or surgery (BCT/BCS) and mastectomy treatments for T1 breast cancers yield comparable recurrence and survival rates. Standards of medical practice for various diseases and conditions are known, but very little, if any, information or research exists on individual hospital medical practice. This study focused on the grassroots level of health care by investigating local treatments chosen concerning early diagnosis of breast cancer.

The major question researched in this study was: Do surgeons influence the treatment rates for T1 breast cancer patients at the local hospital level of health care? The research design focused on a four step approach using descriptive data and explanatory survey data for the time period of January 1991 to May 1994. The steps included: (1) analyzing cross-sectional, demographic, tumor board data, (2) reporting hospital surgical rates for mastectomy and BCT plus creating a timeline, (3) survey general and reconstructive surgeons associated with the medical center as to their beliefs concerning the efficacy of mastectomy and BCT treatments, their beliefs concerning why patients choose mastectomies, and (4) survey T1 breast cancer patients for information regarding their decision-making processes used in their treatments.

A 406 bed medical center located in southwestern Virginia was the site of the study. General and reconstructive surgeons on staff and affiliated with the medical center during January 1991 to May 1994 comprised the medical population to be surveyed. All surviving T1 breast cancer patients treated during the same time frame comprised the population. The surgeon survey tool, used with permission, was a questionnaire developed from a 1992 Colorado study. The patient survey tool was created for the study. To protect the privacy of participants, all responses are confidential and reported only as aggregated data. Local hospital data was found to support national and international statistics. Surgeons were not found to unduly influence the treatment choices of T1 breast cancer patients at the local level of health care. Patients were satisfied with their treatment choices and if given the same circumstances, would make the same decisions again.

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