Minimally invasive breast surgery may be trading better cosmetic outcomes for worse rates of cure, warns a senior doctor in an editorial published on bmj.com today.
Effectiveness and safety, as well as aesthetic outcomes, need to be considered when planning surgery for breast cancer, writes Monica Morrow, Chief of the Breast Service at Memorial Sloan-Kettering Cancer Center in New York. But over the past 30 years, surgery has become increasingly devoted to improving cosmetic outcomes.
New techniques such as oncoplastic and endoscopic surgery, which involve minimal skin incision, are now possible. But a review of the evidence reveals that the oncological safety of these new procedures is often not being evaluated thoroughly.
Morrow is concerned that failure to demand a rigorous evaluation of oncological outcomes as well as cosmetic ones runs the risk of losing some of the gains in survival seen in the past decade.
"We must ensure that surgical approaches designed to improve cosmetic outcomes do not increase local failure and the risk of subsequent death from breast cancer," she says.
She also points out that the developing fields of oncoplastic surgery and minimally invasive breast surgery require rigorous assessment of patient reported outcomes to ensure that new procedures actually improve outcomes that are important to patients.
"The local treatment of breast cancer is based on the results of numerous high quality clinical trials and is therefore a model for evidence based care. As we attempt to advance from good to great cosmetic outcomes it is important that we remember this," she concludes.
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