Haven't you noticed how, when something is in your awareness, it suddenly appears all around you? The usual example is buying a new car and then seeing similar cars everywhere. It happens to me with lots of things, and this is one of them. I spent Monday in Chicago at a Board meeting for NAPBC (National Accreditation Program for Breast Centers: http://www.napbc-breast.org/ (and the website is quite good should you have time and interest)). Anyway, I represent the Association of Oncology Social Work on the Board and, with a few other "random people", comprise the non-surgeons section of the Board. This means that a great deal of the discussion is interesting, but does not give me a chance to say much. When the topic at hand is types of breast biopsies, a social worker has little to contribute.
On Monday, there was a quite feisty discussion about changing one of the standards that requires X percentage of surgeries done at a center be breast conserving surgeries (meaning wide excisions/lumpectomies) rather than mastectomies. As you know if you read this blog regularly, the rate of mastectomy has been rising in the US over the last few years, much to the consternation of many breast surgeons. There are lots of reasons for this, but one of the big ones is patient choice. This inevitably leads to concern that women may not fully understand the natural history of breast cancer and may incorrectly believe that they are reducing their recurrence rate by opting for one or two mastectomies. Surely there are specific situations in which this is correct, but, usually, the smaller surgery is equally effective. During the conversation, it became clear that some of the surgeons present believed that some of their colleagues around the country might be suggesting mastectomies based on personal characteristics of their patients. A given example was an elderly woman who lives 100 miles from the nearest radiation therapy center and "wouldn't want to make that daily drive." At last! An opportunity for a social worker to speak! I immediately reminded the group that no surgeon should be making assumptions about a patient's thoughts or choices, and women should be offered any and all appropriate options.
Off my soapbox. Here is an interesting article from MedScape about this:
Too Few Women Being Offered Breast-Conserving Surgery
October 1, 2012 (Vienna, Austria) - Improvements in breast cancer treatments are making it possible for more womento conserve their breasts after therapy. However, an analysis conducted by Carmen Criscitiello, MD, from the European Institute of Oncology in Milan, Italy, and colleagues has shown that many women who are probable candidates for breast-conserving surgery are instead undergoing mastectomies.
"These results call for a clear consensus on the role of breast-conserving surgery, especially in patients who respond to neoadjuvant therapy," said Dr. Criscitiello. "This will spare more women from receiving radical treatments," she added.
Dr. Criscitiello presented an analysis of data from the Neo-Adjuvant Lapatinib and/or Trastuzumab Treatment Optimization Trial (NeoALTTO). As previously reported by Medscape Medical News, NeoALTTO showed that combined targeted therapy appears to be more effective than a single agent in the treatment of stages I to III HER2-positive breast cancer.