Observational studyMedical care2015
Reexamining the Relationship of Breast Cancer Hospital and Surgical Volume to Mortality: An Instrumental Variable Analysis.
Observational study in Medical care, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
21 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Systematic review of prospective studies focused on regionalization of care in surgical oncology.Updates in surgery · 2021Pooled it
- Relationship between surgeon volume and outcomes: a systematic review of systematic reviews.Systematic reviews · 2016Pooled it
- Associations of surgical breast cancer treatment at regional or community hospitals with patient-reported experience measures.Breast cancer research and treatment · 2026Article
- Effect on Travel Distance of a Statewide Regionalization Policy for Initial Breast Cancer Surgery.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2025Article
- Triangulating Instrumental Variable, confounder adjustment and difference-in-difference methods for comparative effectiveness research in observational data.Wellcome open research · 2025Article
- ASO Author Reflections: Extending Optimal Care for Breast Cancer to the Elderly Population.Annals of surgical oncology · 2023Article
- Associations Between Hospital Volume and Overall Survival After Surgery in Older Patients with Breast Cancer.Annals of surgical oncology · 2023Article
- Surgeon Factors Influencing Breast Surgery Outcomes: A Scoping Review to Define the Modern Breast Surgical Oncologist.Annals of surgical oncology · 2023Article
- Surgeon Factors Influencing Breast Surgery Outcomes: A Scoping Review to Define the Modern Breast Surgical Oncologist.Annals of surgical oncology · 2023Article
- Centralization of Initial Care and Improved Survival of Poor Patients With Breast Cancer.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2023Article
- Adjuvant treatment of surgically treated bone metastasis patients: association with hospital characteristics and trends over time.Medical oncology (Northwood, London, England) · 2023Article
- Breast Cancer Treatment in Integrated Care Process in Andalusia: The Challenge of Multidisciplinarity.International journal of environmental research and public health · 2022Article
- The Influence of Hospital Characteristics on Patient Survival in Surgically Managed Metastatic Disease of Bone: An Analysis of the SEER-Medicare Linked Database.American journal of clinical oncology · 2022Article
- Article
- Patterns and characteristics of patients' selection of cancer surgeons.American journal of surgery · 2021Article
- Optimal surgeon and hospital volume thresholds to reduce mortality and length of stay for CABG.PloS one · 2021Article
- Literature review of data-based models for identification of factors associated with racial disparities in breast cancer mortality.Health systems (Basingstoke, England) · 2019Review
- The Effect of Hospital Volume on Breast Cancer Mortality.Annals of surgery · 2018Article
- Adjusting for confounding by indication in observational studies: a case study in traumatic brain injury.Clinical epidemiology · 2018Article
- Quasi-experimental study designs series-paper 5: a checklist for classifying studies evaluating the effects on health interventions-a taxonomy without labels.Journal of clinical epidemiology · 2017Article
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
objectiveTo reexamine the relationship of hospital and surgical volume to all-cause and breast cancer-specific mortality, taking into account the potential selection bias in patients treated at high-volume centers or by high-volume surgeons. DATA SOURCES: Elderly (65+) women with early-stage, incident breast cancer surgery in 2003. STUDY
designA population-based, prospective survey study.
methodsTwo-stage, instrumental variable regression models. PRINCIPAL
findingsWomen treated in high-volume hospitals were significantly less likely to die of any cause by 5 years after surgery, even after adjustments for self-selection and a number of other factors. The relationship was larger and more significant for breast cancer-specific mortality. Although the general pattern of better mortality outcomes held for moderately sized hospitals, the relationships were not statistically significant. In contrast, there was no relationship of surgeon volume with all-cause or breast cancer-specific mortality.
conclusionsHospital volume, but not surgeon volume, is associated with better survival among women with breast cancer. The magnitude of the potential improvement was substantial and comparable with the benefit conferred by many systemic therapies. These findings highlight the importance of accounting for patient self-selection in volume-outcome analyses, and provide support for policy initiatives aimed at regionalizing breast cancer care in the United States.
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