Issue link: https://viewer.e-digitaledition.com/i/1483585
The Conversation BY CARI WADE GERVIN RESE ARCH CONTINUES TO SHOW THAT MORE AGGRESSIVE SURGICAL TRE ATMENT IS NOT ALWAYS BE T TER FOR SOME BRE A ST CANCER PATIENTS, YE T MANY PHYSICIANS AND PATIENTS CONTINUE TO OPT FOR THE MA XIMALIST APPROACH. IS CHANGE POSSIBLE? THE R ATE OF radical double mastectomies as a f irst-line treatment for early stage breast cancer has increased dramatically in the past decade, despite findings that people with low-grade breast cancer may be receiving unnecessary surgery. "With improvements in systemic ther- apy, bigger surgery is not better surgery, and bigger surgery is certainly associated with more quality-of-life consequences for patients," says Tari A. King, MD, FSSO, Vice Chair for Multidisciplinary Oncolog y in the Department of Surgery and Chief of the Division of Breast Surgery at Brigham and Women's Hospital Dana-Farber/Brigham Cancer Center and Anne E. Dyson Professor of Surgery in the Field of Women's Cancers at Harvard Medical School. "The term de-es- calation has gotten a lot of attention, but it is really about doing the appropriate amount of surgery and/or radiation and/or systemic therapy in the appropriate patients." WHAT THE RESEARCH SHOWS In a recent issue of npj Breast Cancer, a review of the literature shows that breast ca ncer surg ica l practices desig nated a s " low va lue" a re still common. " It 's c h a l l e n g i n g b e c a u s e a l o t o f t h e t r e a t m e nt n or m s i n br e a s t c a n- c er f r om de c a de s a go a r e s o s o ci a l ly ing ra ined — ever yone k nows a woma n who's had bi latera l ma stectomy," says Sa ra h P. Shubeck , M D, MS , A ssist a nt Professor of Surger y at The Universit y of Chicago Pritzker School of Medicine. " We a lso have this notion a round ca ncer that doing the most means doing the most aggressive thing, a nd that must somehow translate into sur viva l outcome. But what you see across multiple large, randomized control tria ls w ith high-qua lit y data is that if we are better able to match a patient with the inter vention needed, they have the sa me benef it." Around in Breast 1 4