The challenge of developing quality measures for breast cancer surgery.

LTHOUGH THE TREATMENT OF CANCER IS INCREASingly multimodal, virtually all patients with solid tumors undergo surgery. In breast cancer, survival after mastectomy, or breast-conserving surgery (BCS) and radiotherapy, are equivalent, 1 and both surgical approaches have a negligible risk of major adverse events. Surgical quality performance measures for cancer have generally focused on 30-day morbidity and mortality rates for higher-risk procedures such as pancreatectomy and esophagectomy. 2 Thus, breast surgery has largely been excluded from the cancer surgical procedures for which quality measures have been developed. Indeed, the focus of quality improvement in breast cancer has primarily been on process measures tied to nonsurgical treatments, including systemic therapies and radiation. 3