Should I shop for a breast cancer surgeon?

A new study of nearly 2,000 patients shows that women who choose a surgeon carefully -- as opposed to those who merely accept a referral from their health plans -- were more likely to be treated by a surgeon who does a high volume of breast surgeries and cared for in a comprehensive cancer program.

Many women, especially if they are poorer or less educated, see whichever surgeon their plan suggests, regardless of whether that surgeon specializes in breast surgery, said Dr. Steven Katz , lead author of the Journal of Clinical Oncology study and a professor of medicine and health management and policy at the University of Michigan.

"We found that women who were involved in the selection of a surgeon were more likely to see an experienced surgeon in a more comprehensive center," said Katz. In general, the more a surgeon specializes, the better the outcome.

Dr. Michele Gadd , a surgeon who specializes in breast cancer at Massachusetts General Hospital, used to perform different kinds of surgery but concluded that she "could only do one well" and now exclusively does breast surgery.

She suggested that women looking for a breast cancer surgeon ask whether the doctor specializes in breast surgery, how many mastectomies the surgeon does in a month -- ideally, the answer is five or more -- and how many lumpectomies (removal of just the cancerous lump) they do -- ideally 15 or so per month.

In addition, she suggested that women ask the surgeon about recurrence rates, "skin-sparing" mastectomies (in which the breast is removed but the skin is saved for a better cosmetic result), nipple-sparing procedures, "sentinel node" biopsies (in which just one or a few lymph nodes are removed, not all the nodes in the armpit), and about "neoadjuvant therapy," in which a woman gets chemotherapy before surgery.

As for whether choosing a surgeon carefully improves outcomes, Katz said his team is about to study that.

JUDY FOREMAN