Reports, such as the recent Breast Cancer Surgery Across Canada by the Canadian Institute for Health Information and the Canadian Partnership Against Cancer, are important to better understand how those involved in health care are performing and to find opportunities for improvement.
It is key, however, that the data is interpreted correctly. This was not the case in the editorial "Cancer care results uneven," published Oct. 14 in the Times Colonist. The report looked at what forms of surgery women with breast cancer choose and what may impact their decisions to have a mastectomy or a lumpectomy. The report does not highlight or imply poor surgical practice.
The report states that overall breast-conserving surgery plus radiation therapy was clinically recommended for the majority of women diagnosed with breast cancer. This is the preferred approach for women with early-stage breast cancer because it is less disfiguring and offers equivalent survival to that of mastectomy.
To state that "surgeon preference" must be the driving force in the choice of surgical procedures for breast cancer cannot be concluded from the report.
Although a surgeon is the point person to inform a patient of her options, many factors influence a woman's decision.
In fact, the report outlines three common factors affecting surgical procedure choices for breast cancer. The factors highlighted were age, income and distance to radiation-therapy treatment. The good news is patients in northern B.C. and the central interior will soon have radiation therapy closer to them with the opening of the new B.C. Cancer Agency Centre for the North this fall. With radiation treatment closer, we hope that more women living in these regions will consider breast-conserving surgery and radiation over mastectomy.
Other factors that can influence a patient's choice, not discussed in the report, include provincial demographics and access to breast-reconstruction services.
Comments about the re-excision rates in British Columbia being high are totally unsubstantiated in the report. The numbers quoted in the editorial were not in the publication and appear totally incorrect from extrapolation of the reported "index" and "final mastectomy" rates.
In addition, different methodology and coding across the country can flaw the interpretation of this data. The mastectomy rate in B.C. is only slightly above the national average, 45 per cent for breast cancer patients during 2007-10 compared to the Canadian average of 44 per cent.
B.C. has one of the lowest mortality rates and highest survival rates of breast cancer in Canada. Part of that success is due to the B.C. Cancer Agency's comprehensive cancer-care program across the province. Oncologists and surgeons base their treatment recommendations on research, evidence and the needs of the patient.
The contributing members to this study are to be congratulated on this work. They have highlighted some variations in cancer care across Canada, influenced by the system and patient factors, which we need to be looked at further. I look forward to more study surrounding this topic so we can continue to improve patient care.
Dr. Chris Baliski is acting head of the surgical oncology program and surgical oncology network for the B.C. Cancer Agency.
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