A cancer expert has warned that minimally-invasive surgery for breast cancer may be less effective at curing patients than traditional surgery.
Dr Monica Morrow of the Memorial Sloan-Kettering Cancer Centre in New York, USA, writes on the website of the British Medical Journal that minimally-invasive surgery "may be trading better cosmetic outcomes for worse rates of cure".
She explains that both success rate and aesthetic outcomes must be considered when planning surgery for breast cancer. Minimally-invasive surgery has become an accepted standard, she writes, "but what level of efficacy or oncological safety must be demonstrated before advocating and performing a new procedure outside the setting of a clinical trial?"
Just because something is technically possible is it not necessarily appropriate, she believes. A recent supporting study was "reassuring, but hardly definitive" because of a small sample size. Nevertheless, the researchers concluded that the technique "provides excellent cosmetic results without reducing oncological safety".
Some types of minimally-invasive surgery make it difficult or impossible to deliver the optimum dose of radiation to the tumour bed, a procedure that improves treatment success, she warns.
New procedures aimed at improving cosmetic outcomes must be evaluated carefully, she states. "We must ensure that new surgical approaches do not increase local failure and the risk of subsequent death from breast cancer."
Rigorous assessment of patient-reported outcomes "will ensure that new procedures that potentially prolong surgery, that may increase the use of resources, and that are associated with uncertain oncological safety actually improve outcomes that are important to patients".
Failure to do so "runs the risk of losing some of the gains in survival seen in the past decade".
Morrow, M. Minimally invasive surgery for breast cancer. The British Medical Journal, 2009;338:b557.
Leave a Reply