McCahill et al provide us with an important first step in measuring multiple surgical parameters involving the treatment of primary invasive and noninvasive breast cancer. Their selection of the 8 quality outcome measures was based on literature as documented in their Table 5. This literature undoubtedly reflects a multidisciplinary diagnostic and therapeutic approach involving radiologists, pathologists, geneticists, medical and radiation oncologists, and both oncologic and reconstructive surgeons. It would be interesting to know how that approach was used in this work. In many high- or very low-volume practices it would be too onerous to have each new patient evaluated by the team, but in those cases standards of care are often adhered to by all involved in breast cancer care. Did such standards exist in the current study or was the team approach used with all of the patients?
Quinlan RM. Quality Measures for Breast Cancer Surgery—Invited Critique. Arch Surg. 2009;144(5):462-463. doi:10.1001/archsurg.2009.57