> Table 52: Hospital volume and breast cancer survival after treatment
This summary table contains detailed information about research studies. While viewing summary tables offers an informative glimpse at the science behind many breast cancer guidelines and recommendations, they should be viewed with some caution. There are a number of concepts you must understand to be able to successfully read and interpret research tables. To get some background information about understanding research tables, please see How to Read a Research Table.
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Introduction: There are few U.S. studies looking at the link between the number of breast cancer surgeries a hospital performs each year (a measure of hospital volume) and survival after treatment [1]. The largest published study (detailed below) followed nearly 48,000 women who had been treated for breast cancer with surgery [2]. Those who were treated at hospitals performing more than 150 breast cancer surgeries a year were less likely to die of breast cancer within five years of their surgery than women who were treated at hospitals performing fewer surgeries per year. Similar results were found in two more studies, one of more than 29,000 women and one of more than 11,000 women [3,4]. However, a smaller study of 2,409 women with breast cancer found no significant difference in survival among women treated at hospitals with high case volume and those treated at hospitals with low case volume [5].
Study selection criteria: Most recent published U.S. studies on hospital volume and breast cancer survival.
Table Note: Relative risk above 1 indicates increased risk. Relative risk below 1 indicates decreased risk.
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Number of
Women Treated with Surgery for Breast Cancer
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Hospital Volume
(number of breast cancer surgeries performed per year)
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Relative Risk of Dying from Breast Cancer within Five Years after Surgery,
RR (95% CI)
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Roohan et al. [2]
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47,890
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<10
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1.60 (1.42-1.81)
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10-50
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1.30 (1.22-1.37)
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50-150
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1.19 (1.12-1.25)
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>150
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1.00 (reference group)
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Skinner et al. [3]
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29,666
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1-35
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1.00 (reference group)
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36-70
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0.92 (0.85-0.99)
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71-125
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0.78 (0.72-0.85)
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>125
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0.77 (0.70-0.84)
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Gilligan et al. [4]
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11,225
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0-19
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1.00 (reference group)
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20-39
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0.80 (0.66-0.97)
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>40
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0.78 (0.64-0.96)
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Harcourt et al. [5]
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2,409
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<10
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1.05
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11-20
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0.98*
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21-30
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1.02
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31-40
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1.00
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>40
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1.00 (reference group)
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* Reference group not identified. No results statistically significant.
References
1. Hillner BE, Smith TJ, Desch CE. Hospital and physician volume or specialization and outcomes in cancer treatment: importance in quality of care. Journal of Clinical Oncology. 18(11):2327-40, 2000.
2. Roohan PJ, Bickell NA, Baptiste MS, et al. Hospital volume differences and five-year survival from breast cancer. Am J Public Health. 88(3):454-7, 1998.
3. Skinner KA, Helsper JT, Deapen D, et al. Breast cancer: Do specialists make a difference? Ann Surg Oncol. 10(6):606-15, 2003.
4. Gilligan MA, Neuner J, Zhang X, Sparapani R, Laud PW, Nattinger AB. Relationship between number of breast cancer operations performed and 5-year survival after treatment for early-stage breast cancer. Am J Public Health. 97(3):539-44, 2007.
5. Harcourt KF, Hicks KL. Is there a relationship between case volume and survival in breast cancer? Am J Surg. 185(5):407-10, 2003.
Updated 09/12/09
