Breast Organ-Specific Surgical Practice: Perspectives of Indian Surgeons

• Arpan Choudhury

  Department of Surgical Oncology, State Cancer Institute, Guwahati, India

• Neelam Ahirwar

  Department of Surgical Oncology, Zydus Hospital, Ahmedabad, India

• Rukmini Bezbaruah

  Department of Oncopathology, Dr. B. Borooah Cancer Institute, Guwahati, India

• Sukruti Dave

  Department of Medical Oncology, Sterling Hospital, Vadodara, India

Objectives: Cancer care is changing rapidly, with many countries embracing organ-specific specialization to offer more focused and effective treatment. In India, however, most surgeons continue to practice in a more generalized way, and we still do not fully understand how they feel about shifting toward subspecialized care. This question becomes especially important in breast cancer—the most common cancer among Indian women—where dedicated expertise can make a real difference in early detection, treatment quality, and patient survival. This study aims to explore how Indian surgeons view breast organ-specific practice, their willingness to adopt it, and the challenges they foresee.

Methods: Cross sectional study conducted in July 2024 in 100 surgeons of India using a self-administered google form questionnaire. Responses were evaluated and assessed.

Results: Out of 100 responses, 45% were from private/corporate setting, 39% from government institutes. 30.6% were from west, 27.6% from east, 22.4% from south and 19.4% from north zone. 55% were from surgical oncology, 36.4% were from general surgery. As per the study, breast (31%) and gastro-intestinal surgery (29%) were the subspeciality of choice. 47.5% agreed that they would be interested in breast specific surgery practice if proper training was available. 30.9% considered this to be less stressful with fewer complications. Majority (48%) thought that lack of patient awareness about breast cancer specific surgeon was the biggest disadvantage of organ specific practice. 22% considered it to be technically undemanding. 51% and 27.1% suggested that a dedicated and recognized training is required and organ specific practices are required at hospitals/institutions respectively. Notably, female surgeons were more likely to choose breast surgery compared to males (50% vs. 20%), a difference that was statistically significant (p = 0.015; 95% Confidence Interval (CI): 1.50–12.25)

Conclusion: Breast organ specific oncosurgery practice is still uncommon in India. More dedicated training programs are required along with adequate employment opportunities to fill the lacunae in promoting the same.

[1] Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: a Cancer Journal for Clinicians 2021; 71(3): 209-249.

[2] Takiar R. Status of Breast and Cervix Cancer in Selected Registries of India 2018; 2: 1-5.

[3] Malvia S, Bagadi SA, Dubey US, Saxena S. Epidemiology of breast cancer in Indian women. Asia-Pacific Journal of Clinical Oncology 2017; 13(4): 289-295.

[4] Sainsbury R, Haward B, Rider L, Johnston C, Round C. Influence of clinician workload and patterns of treatment on survival from breast cancer. Lancet (London, England) 1995; 345(8960): 1265-1270.

[5] Ma M, Bell J, Campbell S, Basnett I, Pollock A, Taylor I. Breast cancer management: is volume related to quality? Clinical Advisory Panel. British Journal of Cancer 1997; 75(11): 1652-1659.

[6] Quinn McGlothin TD. Breast surgery as a specialized practice. American Journal of Surgery 2005; 190(2): 264-268.

[7] Skinner KA, Helsper JT, Deapen D, Ye W, Sposto R. Breast cancer: do specialists make a difference? Annals of Surgical Oncology 2003; 10(6): 606-615.

[8] Gillis CR, Hole DJ. Survival outcome of care by specialist surgeons in breast cancer: a study of 3786 patients in the west of Scotland. BMJ (Clinical research ed.) 1996; 312(7024): 145-148.

[9] Waljee JF, Hawley S, Alderman AK, Morrow M, Katz SJ. Patient satisfaction with treatment of breast cancer: does surgeon specialization matter? Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology 2007; 25(24): 3694-3698.

[10] Pass HA, Klimberg SV, Copeland EM III. Are “Breast-Focused” Surgeons More Competent?. Ann Surg Oncol 2008; 15: 953-955.

[11] Kollias J, Rainsbury R. Surgical trainees' attitudes to specialization in breast surgery. ANZ Journal of Surgery 2003; 73(7): 489-492.

[12] Rainsbury RM, Browne JP. Specialisation in breast surgery: Opinions of UK higher surgical trainees. Bulletin-Royal College of Surgeons of England 2001; 83(9): 298-301.

[13] Cameron IC, Reed MW, Johnson AG. Mismatch between general surgical trainees' sub-specialist interests and advertised jobs: a cause for concern? Annals of the Royal College of Surgeons of England 2001; 83(4): 275-278.

[14] Ainsworth R, Kollias J, Pyke C. Surgical trainee attitudes to specialization in breast surgery. ANZ J Surg 2016; 86(9): 637-8.

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