A clinical research study released
today reveals significant differences in the way U.S. hospitals manage breast
cancer. Women at the nation's top-performing hospitals are more likely to
undergo breast-conserving surgery (BCS) such as lumpectomy, compared to
similar patients at other hospitals, according to the study from the Solucient
Leadership Institute, formerly the HCIA-Sachs Institute. The National
Institutes of Health recommended BCS for eligible patients over 10 years ago.
The study also finds that:
- Compared to patients in the Northeast, women in the South are
21 percent less likely to receive BCS, and women in the West are
17 percent less likely.
- Forty-six percent of Hispanic women undergo BCS, compared to
47.5 percent of African-American women, 48.5 percent of
Asian Americans, and 51.1 percent of Whites.
- Women insured by Medicaid are 69 percent less likely than privately
insured patients to receive immediate breast reconstruction following
- Immediate reconstructive surgery following mastectomy is more common in
top-performing hospitals and teaching hospitals compared to community
- When it comes to radiation therapy following BCS, patients are most
likely to undergo this treatment in top-performing hospitals, as well
as in hospitals in the Western region; moreover, younger patients are
more likely than older patients to receive post-BCS radiation.
"The good news is that top-performing hospitals are clearly leading the
industry in providing more progressive initial treatment and follow up of
breast cancer," says Jean Chenoweth, executive director of the Solucient
"However, an additional area of concern identified in this study is that
women on Medicaid are significantly less likely to have immediate
reconstructive surgery than privately insured women," Chenoweth adds. "This
underscores the fact that women with breast cancer may not be being offered
the same options, and that some treatments may not reflect best practice and
According to the National Cancer Institute, one in 10 U.S. women who live
to age 80 will develop breast cancer in their lifetime. More alarming, breast
cancer remains the most common cause of cancer death among women between ages
35 and 54. However, when detected early and treated appropriately, breast
cancer victims may expect a five-year survival rate of 95 percent. The two
major surgical approaches to treating breast cancer are BCS and mastectomy.
The purpose of the study, "100 Top Hospitals' Clinical Research Program:
Management of Breast Cancer," was to examine how top-performing 100 Top
Hospitals compare with other hospitals in each of three outcomes: use of BCS,
use of radiation therapy following BCS, and the performance of immediate
breast reconstruction following mastectomy.
Data from the following sources were compared in the study: the MedPar
database, Solucient's proprietary all payer data base, the Health Care
Financing Administration's Standard Analytical Files (SAF), and data from
winners of the 100 Top Hospitals award, a strictly empirical evaluation of
clinical and financial performance.