Breast Cancer Evaluation and Follow-up: a Survey of The Ohio Chapter of The American College of Surgeons

Preoperative evaluation and postoperative follow-up of breast cancer patients vary considerably. Recent literature suggests that routine surveillance studies for breast cancer patients can be reduced without compromising the outcome. The Ohio State Chapter of The American College of Surgeons Committee on Cancer sponsored a survey of its general surgeon fellows to determine their practice philosophies regarding these issues. The questions centered around breast cancer screening, evaluation and treatment, and follow-up. The fellows were also questioned as to their opinions regarding practice parameters and whether the State Chapter should take a role in this area. Of the 764 surveys sent out, 34.2% were appropriate for evaluation. For breast cancer screening, 96.1% believe yearly mammography is important. Newly diagnosed breast cancer patients are generally evaluated with history and physical exam, chest X-ray, complete blood cell count, and liver function tests. Bone scans are used by 38.6% of surgeons. Most patients with positive lymph nodes see a medical oncologist. About half of primary breast cancer treatment (44.7%) is by breast preservation. Essentially all surgeons follow their patients after treatment for breast cancer surveillance. Essentially all surgeons feel that physical exam and mammograms are important for post-treatment follow-up. Complete blood cell count, liver function studies, and chest X-rays are used less commonly but still by more than half of the surgeons. 44.4% of the surgeons have found difficulty with third-party payers covering the costs of surveillance studies. 87.7% of surgeons surveyed felt the State Chapter should become involved in establishing clinical guidelines or practice parameters.