It's become an axiom of medicine, a finding replicated in numerous studies: Cancer patients whose surgery is performed by doctors and hospitals that handle few similar procedures tend to fare worse -- sometimes much worse -- than those whose operations are performed by more experienced practitioners.

Yet a new study of ovarian cancer patients in Maryland has found that the majority of women diagnosed between 1990 and 2000 were treated not by specialists, but by doctors without specialized training who performed only one to four ovarian cancer operations annually.

"If you were going to have cardiac bypass surgery, you wouldn't just go to your family doctor or pick a surgeon who did one per year," said Robert E. Bristow, chief of the Kelly Gynecologic Oncology Service at Johns Hopkins Hospital and lead author of the study, published in the May issue of Gynecologic Oncology.

Bristow and his colleagues found that of the 2,417 ovarian cancer surgeries performed in Maryland over an 11-year period, 56 percent were performed by surgeons who did fewer than four of the demanding, technically complex surgeries per year.

Most of these women had their operations at community hospitals that treat only a few ovarian cancer patients, whose medical and psychological needs can be complicated because the disease is usually diagnosed at an advanced stage.

Only 14 percent were treated at hospitals by surgeons who handled more than 20 cases annually, said Bristow.

Other studies have found that ovarian cancer patients treated by experienced surgeons typically live two to three times longer than those whose initial surgeries were performed by low-volume surgeons. "That can be the difference between surviving 1 1/2 and five years," Bristow said.

"The important thing is to draw attention to this issue," he added.

Hopkins, he said, has recently instituted a program in which women with a suspected ovarian cancer diagnosis will be seen by a gynecologic oncologist within 24 hours after they call or are referred by a physician.

-- Sandra G. Boodman