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Choosing Wisely in Cancer Surgery

Posted 9/10/2013

Posted in

  I suspect that the title of this post is somewhat misleading as I am thinking about the American Board of Internal Medicine's Choose Wisely campaign, not about making careful choices for one's self. You may be familiar with this initiative that began in 2010 when each medical speciality (including oncology) was asked to look carefully at practices that are common in their field but lack evidence to any value..

  Full disclosure would include mentioning that my husband has been directing the oncology effort, working under the auspices of ASCO. This particular artice, from Medscape, about not about medical oncology (his purview), but cancer surgery. The topic is surely broader than breast cancer surgery, but I suspect you are interested in the larger view. Here is a list of the suggestions and a link to read the article:

Seven Common Cancer Surgery Practices That Should Stop

The ACS has issued the following 2 recommendations:
Do not perform axillary lymph node dissection for clinical stage I or II breast cancer with clinically negative lymph
nodes without attempting sentinel node biopsy.
Avoid colorectal cancer screening tests for asymptomatic patients with a life expectancy of less than 10 years
and no family or personal history of colorectal neoplasia.

In addition, the Commission on Cancer has issued the following 5 recommendations:

Do not perform surgery to remove a breast lump for suspicious findings unless a needle biopsy cannot be done.
Do not initiate surveillance testing after cancer treatment without providing the patient with a survivorship care
Do not use surgery as the initial treatment without considering whether presurgical (neoadjuvant) systemic and/or
radiation therapy can be effective at improving local cancer control, quality of life, or survival.
Do not perform major abdominal surgery or thoracic surgery without a pathway or standard protocol for
postoperative pain control and pneumonia prevention.
Do not initiate cancer treatment without defining the extent of the cancer (through clinical staging) and discussing
the intent of treatment with the patient.
The supporting literature citations and expanded explanations for the ACS and Commission on Cancer lists are posted on the ACS Web site and on the Choosing Wisely Web site.


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