High-Volume Hospitals Have the Greatest Success in the Fight Against Breast Cancer

By Scott Behm, Department of Surgery

Breast cancer is the most prevalent cancer diagnosis for women in the United States, with over a quarter million new cases reported in 2016. While incidence rates have decreased in the U.S. since 2000, the treatment of breast cancer has become more varied and complex in recent years, with systemic therapy, surgery, and radiation offering diverse approaches to treatment. The success of these treatments varies from patient to patient, but a new study led by Dr. Rachel A. Greenup, Assistant Professor, Division of Advanced Oncologic and Gastrointestinal Surgery, concludes that there is one factor that can be linked to patient survival: hospital volume. 

The study, titled “The Effect of Hospital Volume on Breast Cancer Mortality,” examined cases of over a million patients diagnosed with unilateral stage 0-III in situ or invasive breast cancer from 2004 to 2012. The 1,277 hospitals included in the study were classified as low-volume (less than 148 cases per year), moderate-volume (148 to 298 cases per year), and high-volume (more than 298 cases per year). The results of the study revealed that patients treated at high-volume facilities had an 11% lower mortality rate than those at low-volume facilities. 

The findings raise important questions about breast cancer treatment in the United States. The subgroup data of the study showed that patients at low-volume centers were more likely to be on government insurance and have a lower level of education. Meanwhile, patient safety organizations typically invest in high-volume hospitals, where more patients can benefit from these funds. The study also shed light on ethnicity variables in patient outcomes, showing that regardless of hospital volume, non-Hispanic black patients had a 20% higher mortality rate.         

The study was published in the Annals of Surgery and was co-authored by Samantha Thomas, Biostatistician, Department of Biostatistics and Bioinformatics; Dr. Whitney O. Lane, General Surgery Resident; Dr. Rachel Blitzblau, Assistant Professor, Department of Radiation Oncology; Dr. Terry Hyslop, Professor, Department of Biostatistics and Bioinformatics; and Dr. Shelley Hwang, Professor, Division of Advanced Oncologic and Gastrointestinal Surgery.

The authors conclude that low-volume centers should be supported by resources at the regional level in order to bridge any gaps in treatment, ensuring high quality care to the hundreds of thousands of breast cancer patients seeking treatment each year.

"The Effect of Hospital Volume on Breast Cancer Mortality"

Ann Surg. 2016 Nov 23. [Epub ahead of print]