Population-based Study of the Relationship Between Hospital Surgical Volume and 10-year Survival of Breast Cancer Patients in Osaka, Japan

Breast cancer is the most prevalent cancer among Japanese women; however, its outcome has never been analyzed in relation to hospital volume in Japan. We utilized data from the Osaka Cancer Registry for investigating correlations between hospital volume and 10-year survival of breast cancer patients. According to the total number of surgical procedures of breast cancer in each hospital during the period 1985-1991, we classified reporting hospitals in Osaka into four categories (high, medium, low, very low). The survival analysis was restricted to the 4333 female patients reported who were 30-64 years old, living in Osaka Prefecture (except for Osaka City), and for whom active follow up was available more than 10 years after diagnosis. In total, the relative 10-year survival was 79.7% in the high-volume, 80.3% in the medium-volume, 78.2% in the low-volume, and 68.2% in the very low-volume hospitals. After adjustment for age at diagnosis, clinical stage and clues for detection with the Cox regression model, the patients who received care in the very low-volume hospitals had a significantly higher risk of death than those in the high-volume hospitals. Meanwhile, no significant differences in risk were observed for the other two categories. These findings led us to conclude that the surgical volume of the hospitals did not affect the 10-year survival rate significantly, except for the very low-volume hospitals in Osaka, Japan. However, the study of these relationships should be continued and expanded in future to include quality of life.