Surgery News - February 2009 - (Page 13) FEBRUARY 2009 • SURGERY NEWS ONCOLOGY 13 Expert Argues Against Routine MRI for Breast Cancer BY BRUCE JANCIN Else vier Global Medical Ne ws S A N A N T O N I O — Magnetic resonance imaging should not be part of the routine presurgical evaluation of breast cancer patients, because evidence of its clinical benefit does not exist, a leading surgeon said in a plenary lecture at the San Antonio Breast Cancer Symposium. “MRI finds two to three times more disease than observed rates of local recurrence in patients selected [for breastconserving surgery] without MRI. This results in an increased mastectomy rate for questionable patient benefit. To date, neither short-term surgical outcomes nor long-term local control or contralateral breast cancer rates are improved with MRI,” said Dr. Monica Morrow, an ACS Fellow and chief of the breast service in the department of surgery at Memorial Sloan-Kettering Cancer Center, New York. And yet, MRI is routinely used presurgically in breast cancer patients because MRI improves neither short-term surgical outcomes nor long-term local control or breast cancer rates. DR. MORROW superior to conventional adjuvant therapy. Endocrine therapy will not result in a survival advantage; chemotherapy is better. Treatment of breast cancer with less than mastectomy is dangerous. Local therapy does not influence survival. And to that list I would add, MRI finds cancer not found by other modalities and therefore must be helpful.” She argued that MRI benefits breast cancer patients only in relatively uncommon circumstances, such as when looking for an occult primary tumor in women with axillary adenopathy in whom standard imaging and clinical examination are uninformative; assessing response to neoadjuvant therapy in patients who desire breast-conserving therapy; and resolving discrepancies between conventional imaging and clinical examination findings. “To me, this was the most important talk of the day in terms of changing clinical practice. This information needs to get out to the community,” said Dr. Richard L. Crownover, a radiation oncologist at the University of Texas, San Antonio, who commented on the lecture. “We’ve really adopted MRI fanatically. It costs about $1,600 per study out of somebody’s pocket. There is this consistent finding of an increased mastectomy rate—almost twofold for the patients who’ve taken the path through MRI,” he said. New from the American College of Surgeons and Thomson Healthcare I Need an Operation Now What? A Patient’s Guide to a Safe and Successful Outcome I Need an Operation…Now What? gives patients the information they need to boost their chances of having a successful surgical experience, with the best possible results. Written in patient-friendly, nontechnical language, this book is designed to help patients understand the process of having an operation from start to finish. Inside they’ll learn: » How to find a qualified surgeon—one who’s right for them » When to get a second opinion about their treatment—and how to go about finding one » How to ask about the risks and benefits of having an operation » How to prepare for an operation—from what to pack and what to wear to when to stop eating » What to expect, including advice from patients who’ve had various operations, from major gastrointestinal procedures to back surgery—and who will care for them—while in the hospital » Numerous "insider's" tips, such as how to help prevent infection and the best times to schedule an operation » All the costs of the operation » How to ensure a comfortable recovery period The experts agree “Along with your love and support, the greatest gift you can give a loved one or friend facing or weighing the benefits and risks of surgery is a copy of this book. With his thoughtful, clear, very accessible writing, Dr. Russell, with the American College of Surgeons, provides a wealth of informational resources that every patient can draw on. He gives excellent advice on how to ask good questions and become an informed, empowered consumer. Most importantly, he urges you, the patient, to ‘take control and become fully informed about your options.’ This book will help you do that, prepare you for the effects of surgery and how to deal with them and give you confidence as you navigate through the health care system.” Helen Darling, president of the ISBN 13: 978156363-700-1 Pub. Jan 2008 • Paperback $19.95 • 125 pp National Business Group on Health it is thought to reduce the number of excisions needed to obtain negative margins or prevent mastectomy. Dr. Morrow cited a recent survey of active members of the Society of Breast Imaging that showed 94% considered preoperative determination of the extent of cancer to be a leading indication for the imaging procedure (AJR Am. J. Roentgenol. 2008;191:332-9). A recent retrospective study of 756 women who underwent breast-conserving therapy at the Hospital of the University of Pennsylvania, Philadelphia, found that the 8-year local failure rate was 3% in women who underwent preop MRI and 4% in those who did not. Contralateral breast cancer rates were 6% in each group. The overall survival rate was 86% with MRI and 87% without ( J. Clin. Oncol. 2008:26:386-91). Similarly, in a retrospective study of the effect of MRI on short-term outcomes in 577 breast cancer patients, Dr. Morrow and her coworkers found a 21.6% positive-margin rate at initial lumpectomy in 130 women with a preoperative MRI versus 14% in those with no MRI. The conversion rate from breast-conserving therapy to mastectomy was 9.8% in the MRI group versus 5.9% with no MRI. After the researchers controlled for tumor stage, MRI was associated with a 1.8-fold increased likelihood of mastectomy. “The history of breast cancer is littered with intuitively obvious concepts that were wrong,” Dr. Morrow said. “Some of my favorites: High-dose chemotherapy and bone marrow transplantation is “Like a true professional, Dr. Russell gives surgical patients-to-be all the information and support needed to make decisions that meet their needs as only they can know them. This book is not only practical, but also highly respectful, most educational. Patients can use this book to navigate through their surgical experience while we all push for a better-organized health care delivery system.” Richard J. Umbdenstock, president and CEO of the American Hospital Association “Research shows that people who are well informed about their treatment options enjoy better surgical outcomes and are more satisfied with their results.” To order or for further information visit http://www.facs.org/public_info/patientguidebook.html or call 312/202-5474 http://www.facs.org/public_info/patientguidebook.html
Table of Contents Feed for the Digital Edition of Surgery News - February 2009 Surgery News - February 2009 Contents The 20/20 Vision ICD-10 Looms News From the College: MedPAC Flak Oncology: Best for Breast General Surgery: Weighty Problem Surgery News - February 2009 Surgery News - February 2009 - Contents (Page 1) Surgery News - February 2009 - Contents (Page 2) Surgery News - February 2009 - Contents (Page 3) Surgery News - February 2009 - Contents (Page 4) Surgery News - February 2009 - The 20/20 Vision ICD-10 Looms (Page 5) Surgery News - February 2009 - The 20/20 Vision ICD-10 Looms (Page 6) Surgery News - February 2009 - The 20/20 Vision ICD-10 Looms (Page 7) Surgery News - February 2009 - News From the College: MedPAC Flak (Page 8) Surgery News - February 2009 - News From the College: MedPAC Flak (Page 9) Surgery News - February 2009 - News From the College: MedPAC Flak (Page 10) Surgery News - February 2009 - News From the College: MedPAC Flak (Page 11) Surgery News - February 2009 - Oncology: Best for Breast (Page 12) Surgery News - February 2009 - Oncology: Best for Breast (Page 13) Surgery News - February 2009 - Oncology: Best for Breast (Page 14) Surgery News - February 2009 - Oncology: Best for Breast (Page 15) Surgery News - February 2009 - Oncology: Best for Breast (Page 16) Surgery News - February 2009 - Oncology: Best for Breast (Page 17) Surgery News - February 2009 - Oncology: Best for Breast (Page 18) Surgery News - February 2009 - General Surgery: Weighty Problem (Page 19) Surgery News - February 2009 - General Surgery: Weighty Problem (Page 20)
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