Patterns and correlates of patient referral to surgeons for treatment of breast cancer

Purpose Characteristics of surgeons and their hospitals have been associated with cancer treatments and outcomes. However, little is known about factors that are associated with referral pathways. Methods We analyzed tumor registry and survey data from women with breast cancer diagnosed in 2002 and reported to the Detroit and Los Angeles Surveillance, Epidemiology, and End Results registries (n = 1,844; response rate, 77.4%) and their attending surgeons (n = 365; response rate 80.0%). Results About half of the patients (54.3%) reported that they were referred to the surgeon by another provider or health plan; 20.3% reported that they selected the surgeon; and 21.9% reported that they both were referred and were involved in selecting the surgeon. Patients who selected the surgeon based on reputation were more likely to have received treatment from a high-volume surgeon (adjusted odds ratio [OR], 2.2; 95% Cl, 1.5 to 3.4) and more likely to have been treated in an American College of Surgeons-approved cancer program or a National Cancer Institute (NCI) - designated cancer center (adjusted OR, 2.0; 95% Cl, 1.3 to 3.1; adjusted OR, 3.4; 95% Cl, 1.9 to 6.2, respectively). Patients who were referred to the surgeon were less likely to be treated in an NCI-designated cancer center (adjusted OR, 0.5; 95% Cl, 0.3 to 0.9). Conclusion Women with breast cancer who actively participate in the surgeon selection process are more likely to be treated by more experienced surgeons and in hospitals with cancer programs. Patients should be aware that provider or health plan - based referral may not connect them with the most experienced surgeon or comprehensive practice setting in their community.