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More centralisation of services is not needed
EDITOR,--Charles R Gillis and David J Hole may have found evidence that survival of patients with breast cancer is improved if they are treated by specialist breast surgeons, but there is little scientific evidence that surgery influences survival from breast cancer to any significant extent and they collected no information on the details of treatment received.1 There is considerable evidence, however, to support the survival benefit of adjuvant hormone therapy and chemotherapy2 and of long term benefit from adjuvant radiotherapy.3 Correlation does not prove causation. If encouraging surgeons to work more closely with oncologists can achieve better access to adjuvant treatment and produce improved survival, this would be a much cheaper solution than to create large numbers of specialist breast units. The latter solution should be subjected to a full health technology assessment before being widely adopted.
The gain in treatment benefit of referral to so called specialists over and
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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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Whitehead, M.
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116: 256-263
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