Letters

Specialist surgeons and survival in breast cancer

EDITOR,--There have now been several studies of comparative survival of women with breast cancer under the care of different surgeons. Charles R Gillis and David J Hole's unique and revealing analysis in west Scotland is a further indictment of the haphazard organisation of NHS cancer services.¹ If the findings of this study are extrapolated nationally, then nearly 11000 women died unnecessarily during the 1980s--surely a major scandal of neglect and apathy by successive health ministers.

But the problem is not one of surgical skill; it is a problem of service organisation. There is no evidence whatsoever that the type or quality of surgery has an impact on survival. The most likely reason for the variation in outcome is the failure to refer for adjuvant systemic chemotherapy or tamoxifen. Breast cancer kills because of metastasis. Specialist surgeons work closely with colleagues in . . . [Full text of this article]

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Relevant Article

Survival outcome of care by specialist surgeons in breast cancer: a study of 3786 patients in the west of Scotland

Charles R Gillis and David J Hole
BMJ 1996 312: 145-148. [Abstract] [Full Text]

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• Epstein, R. (1996). Treating breast cancer before surgery. BMJ 313: 1345-1346 [Full text]  
• Gillis, C. R, Hole, D. J (1996). Authors' reply. BMJ 313: 495-495 [Full text]  
• Haward, R A, Forman, D (1996). Specialist surgeons and survival in breast cancer. BMJ 313: 494a-494 [Full text]  
• Ball, A. (1996). Treating a specified number of patients is no guarantee of quality. BMJ 313: 494b-495 [Full text]