Recent innovations in breast cancer surgery that allow doctors to minimize postsurgical breast deformities may be stressing cosmetic outcomes to the detriment of actual rates of cure, a senior physician warned recently.

"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," said Monica Morrow, chief of the Breast Service at Memorial Sloan-Kettering Cancer Center in New York. Her editorial was published on the British Medical Journal website.

The physician's primary concerns in planning breast cancer surgery, she wrote, must always be effectiveness and safety. Esthetic considerations, which have become increasingly prominent among surgeons over the past three decades, must remain secondary.

In recent years, the new techniques of oncoplastic and endoscopic surgery, which involve minimal skin incision, have become more and more attractive to surgeons and patients alike. But, Morrow said, the results of such procedures are not being adequately evaluated from the point of view of their effectiveness and cure rates versus their more-invasive surgical cousins.

Medicine has achieved considerable advances in breast cancer survival over the past decade, but, Morrow warned, it risks falling back in this area if cosmetics are imprudently emphasized.

"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 said.

Morrow also called for rigorous evaluation of patient-reported outcomes of procedures performed using oncoplastic surgery or minimally invasive breast surgery. She said the data so gathered would make sure that new procedures actually result in what patients see as improved outcomes for themselves.

"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 concluded.

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Source: http://www.sciencedaily.com/releases/2009/02/090219202730.htm

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