Science and Surgical Choices
This is an important commentary from the Journal of the National Cancer Institute about science and surgical choices. Specifically, it addresses the question as to whether surgeons are making decisions based on scientific results and data (the answer appears to sometimes be "no"). The author, Dr Bernard Fisher, is a renowned surgeon at the University of Pittsburgh. Dr Fisher and his group are largely responsible for the studies which led to the understanding that, in many situations, a lumpectomy/wide excision and radiation are comparable to mastectomy.
Here is the beginning and then a link:
Role of Science in the Treatment of Breast Cancer When Tumor Multicentricity is Present
During the past 100 years, there have been two major controversies with regard to the treatment of primary breast cancer. The first controversy, which occurred approximately 35 years ago, questioned the performance of radical mastectomy, as originally proposed by Halsted in the 1890s. That controversy was resolved by the use of laboratory and clinical research, hypothesis formulation, and evaluation of the efficacy of the latter through the conduct of randomized clinical trials. A second major controversy arose when magnetic resonance imaging began to detect the presence of tumor multicentricity in many breast cancer patients, resulting in a resurgence in mastectomy in women who could have been treated with breast-preserving surgery.
Because the use of science resolved the first controversy, I investigated whether there was scientific evidence to justify the
current reversion to mastectomy. Extensive examination of the vast amount of recent medical literature related to that subject,
that is, individual articles, review articles, and reports from the use of clinical trials, demonstrated that many physicians are not
familiar with the scientific method, and thus, were unable to present, in those articles, credible evidence to support mastectomy in the presence of tumor cell multicentricity. Aside from the randomized clinical trial conducted by the National Surgical Adjuvant Breast and Bowel Project begun in 1976, which demonstrated no statistically significant difference in disease-free survival, distant disease-free survival, and overall survival between mastectomy and lumpectomy with or without radiation therapy, there has been no information in any of the few recently conducted studies involving multicentricity to justify the current resurgence in mastectomy.
J Natl Cancer Inst 2011;103:1292-1298
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