"The study shows, consistent with earlier research, that site of care can make a difference in outcomes for patients with breast cancer," says Vivek Goel, MD, chair of the department of health administration at the University of Toronto. "Patients need to consider where they get treated along with who does their treatment."

The study results speak for themselves: the five-year survival rate for women treated at teaching hospitals was 92.5% ? a 4% better chance than those treated at community hospitals. Women with small tumors who were treated at teaching hospitals also showed a 53% reduction in the risk of death. But women from high-income neighborhoods tended to have a better survival rate regardless of which hospital they chose for care.

So what exactly explains this phenomenon? Many say it?s found in the term "multi-disciplinary care."

"The multi-disciplinary approach is the answer, "says Herman Kattlove, MD, medical editor for the American Cancer Society and an oncologist. "Academic settings may have more healthcare providers aware of the latest advances. So there?s a little better care at academic centers. Often, there is a pathologist, surgeon, radiologist, medical oncologist, and radiation oncologist. They will all be involved to get the appropriate treatment planned. All therapeutic options need to be presented to the patient," he says.

The research, led by Ruhee Chaudhry, followed the progress of 938 women initially diagnosed with breast cancer in 1991. These women were chosen randomly from the Ontario Cancer Registry and separated in groups ? those who had initial breast cancer surgery in an academic hospital and those who did so at a community hospital. The researchers found that women at the teaching hospitals were more likely to have more careful inspection of their lymph nodes after surgery and also were more likely to receive some kind of adjuvant therapy after surgery to prevent recurrence. Adjuvant therapy is treatment used in addition to the main treatment.

In some community hospitals, a surgeon will see a breast cancer patient for her initial surgery and then, after a lumpectomy or mastectomy, will inform the patient that the tumor is removed and that is all there is to the situation, Kattlove explains. Academic hospitals will typically have a team of doctors working together who can present follow-up treatment options that can aid in the prevention of relapse, he says.

It is important to remember, however, that many community hospitals do have a team of doctors working together, says Kattlove. So for those whose health insurance mandates treatment at a particular hospital, they may still receive appropriate care, he says. This study shows that patients should take a proactive stance and request consultation from other doctors, such as the team that Kattlove recommends.

"We believe that it is a multi-disciplinary, comprehensive approach to treatment that makes a difference. This includes quick access to imaging, pathology, oncology, and supportive care services," says Goel. "Patients should look to see that the hospital [they choose] has such a comprehensive approach, or is part of a network that provides such an approach."