On Referral Patterns for Patients with Breast Cancer

Editorial: In this issue of the Journal of Clinical Oncology, Katz et al. describe mechanisms by which newly diagnosed breast cancer patients report selecting their surgeons in two large cities. They found that 54% of women reported that they were referred to their surgeon by a clinician or health plan, 22% reported they self-selected a surgeon despite having been referred by their clinician or health plan, and 20% self-selected their surgeons without a referral. Patients who selected their own surgeons were more likely to be treated by high volume providers in an American College of Surgeon--approved cancer program or National Cancer Institute--designated cancer center. The authors raise concerns for women who are directed by clinician referrals and health plans to surgeons with lower volume and not necessarily associated with cancer programs.