Facility Size and Its Influence on the Presentation and Treatment of In Situ Breast Carcinoma in the United States

Studies have suggested that outcomes from breast cancer are improved when treatment is rendered at high-volume teaching centers. The current study was undertaken to examine the impact of facility type on the presentation and treatment of "early" breast carcinoma across the United States. Breast cancer data were available from the American College of Surgeons National Cancer Database. The cohort consisted of 305,358 patients presenting with in situ cancers and no prior treatment from 2000 to 2008. Data were stratified by type of treatment facility, "invasive" versus "noninvasive" nature of the tumor, and treatment performed. Only 15 per cent of patients presented to community cancer centers (CCCs). Despite this, a greater percentage presented with invasive disease at CCCs (82.1%) compared with comprehensive community cancer centers (CCCCs; 80%) or teaching/research facilities (T/Rs; 70.2%). In examining the in situ cohort, a higher percentage of patients at CCCs were treated with breast conservation than at CCCCs or T/Rs. Although small, these differences were statistically significant. These data do not support the contention that only "early" cases of breast cancer present and are treated at community centers. In early breast cancer, patients are as likely to receive state-of-the-art treatment at a CCC as they are at a T/R.