Volumes of cancer surgery for breast, colorectal and ovarian cancer 1992–97: is there evidence of increasing sub-specialization by surgeons?

The ‘Calman–Hine Report’ (1995) recommended that cancer surgery should be limited to ‘high-volume’ consultants. Through an analysis of 5 years of Hospital Episode Statistics for the West Midlands region (1992–1997), we have investigated whether there is evidence of increasing numbers of patients with breast, colorectal or ovarian cancer being treated by high throughput, i.e. sub-specialist surgeons, who carry out more than a threshold level of primary cancer resections annually. The proportion of cases treated by the high-volume breast, colorectal and ovarian cancer surgeons increased annually during the 5 years. The absolute number of consultant firms who undertook breast cancer resections reduced during the 5 years; but the number doing colorectal and ovarian surgery increased. Throughout the 5 years, half of the ovarian cancer resections were carried out by consultant firms who did very few procedures – less than 5 of these procedures annually. The relatively high case-load, the elective nature of breast cancer surgery and an early policy change have undoubtedly facilitated the move towards sub-specialization. The weaker trends for colorectal and ovarian cancer surgery suggest continued monitoring is required to ensure that there is a reduction in the proportion of people treated by surgeons who undertake few cancer resections annually. © 2001 Cancer Research Campaign www.bjcancer.com