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Research Letter
October 13, 2008

Integrating Medical Breast Specialists Into the Traditional Breast Center Practice Model: A Review of 11 Years of Experience

Arch Intern Med. 2008;168(18):2042-2045. doi:10.1001/archinte.168.18.2042

The development of comprehensive, multidisciplinary breast centers over the past 30 years reflects advances in breast cancer detection, diagnosis, and treatment. Subspecialties within the field of breast disease, including surgical oncologists, radiologists, medical oncologists, and pathologists, have emerged to diagnose and treat benign and malignant breast disease, and these subspecialties generally define the multidisciplinary breast center model at most institutions.1-6 Under this model, the surgical breast specialist (SBS) triages and manages all patients, whether surgical intervention is required or not.

The Cleveland Clinic Breast Center, Cleveland, Ohio, which opened in 1995, was based on this surgeon-directed practice model. Since its inception, it has offered full-time surgical oncology and breast radiology services and part-time medical oncology, radiation oncology, and plastic surgery services as needed. Initially, the appointment scheduling process directed all patients, including those new to the center or those who had been seen previously, to the surgeons' schedules for evaluation prior to making a determination if the patient were a likely surgical candidate, resulting in continual accrual of patients who neither had breast cancer nor required a breast operation. In addition, and because there were no other options available, these patients returned for routine follow-up examination, further compounding the matter of nonsurgical patients filling the surgeons' schedules and, therefore, delaying access to surgeons for those patients newly diagnosed with breast cancer or other suspicious abnormalities requiring immediate attention.

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