You find a lump in your breast. You report it to your doctor, and a mammogram becomes an MRI, then a biopsy, then a diagnosis: breast cancer.

What’s your next move?

You do what your doctor tells you. You set up appointments at your local hospital with a surgeon to remove the tumor, and an oncologist to direct your treatment. You plunge in: surgery, chemo, radiation, drugs.

Treatment finished, you live happily ever after. Right?

Maybe. But maybe not. And the difference might be where you get your treatment.

Fifty-eight cancer centers and hospitals around the country have earned National Cancer Institute designation as top facilities for treating cancer. These hospitals meet and maintain very high standards in “research, excellence in patient care, training and education, demonstration of technologies, and cancer control,” according to the NCI Web site.

And do these top cancer centers come through where it counts – in saving patients’ lives?

Apparently, they do. Several recent studies have shown that NCI Cancer Centers offer patients demonstrably better survival rates than community hospitals. A recent Dartmouth Medical School study, involving lung, breast, colon, and prostate cancer, showed that nationally, mortality rates for patients receiving care at NCI Cancer Centers were 25% lower, after 1 year, than for those treated at community hospitals.

And this was true for all stages of cancer. In fact, there was an even greater disparity between NCI hospitals and community hospitals for patients with later-stage cancer, or those with other health problems, such as diabetes or congestive heart failure.

NCI hospitals save more patient lives. But why? Is it more money for better equipment, cutting edge drugs…? What’s the difference?

Surprisingly, it’s not the most up-to-date equipment or drugs that make the difference. An article last fall in “Newsweek” magazine  (“What You Don’t Know Might Kill You” – October 26, 2009), offers the following possible reasons:

•Patient volume. The more patients treated, the more data, the more guidance physicians have in directing treatment.

•The number of available specialists, and their level of knowledge and experience. NCI hospitals tend to attract the nation’s best oncologists, and oncological surgeons and radiologists. These doctors have treated many cancer patients (see “patient volume,” above); they have access to the latest research (one of the standards NCI hospitals must meet is excellence in research); and they can call on one another for second opinions.

For example, a community hospital might have one or two oncologists, total. The Fred Hutchinson Cancer Research Center in Seattle, part of the NCI network, has 24 oncologists in the breast program alone.

•NCI centers are better at making the initial diagnosis. Patients receiving a second opinion at an NCI center, after having first been diagnosed at a community hospital, are often found to have more extensive cancer, or a different sub-type. NCI centers also tend to identify cancer where none was found in patients whose first contact was at a community hospital.