Minimally invasive breast surgery 'favours cosmetics rather than efficacy'
An expert has warned that new techniques which improve the visible results of breast surgery may focus too much on cosmetic outcomes and not enough on actual cure rates.
Dr Monica Morrow, chief of breast services and chair in clinical oncology at the Memorial Sloan Kettering Cancer Centre in New York, accepts that both clinical effectiveness and aesthetic outcomes need to be considered when planning surgery for breast cancer.
However, her concern is that in some cases, women's chances of successful cancer treatment are being compromised by the desire to achieve a better cosmetic outcome.
- Dr Lesley Walker, director of cancer information, Cancer Research UK
Writing in an editorial on bmj.com, Dr Morrow describes minimally invasive and oncoplastic breast surgery as "new buzzwords" among breast surgeons and explains that they are designed to improve cosmetic outcomes.
Oncoplastic surgery involves a single surgeon who aims to conserve breast tissue and reconstruct the breast after the cancerous tissue has been removed, while minimally invasive breast surgery is now usually used to describe endoscopic breast and axillary surgery, where only a small incision is made.
However, Dr Morrow wonders what level of efficacy must be demonstrated before such a procedure is advocated and questions: "Just because something is technically possible, is it necessarily appropriate?"
For instance, Dr Morrow cites one study which involved just 33 patients with extensive ductal carcinoma in situ who underwent endoscopic assisted skin sparing mastectomy.
Despite only carrying out a 51-month follow-up on this small number of patients, the researchers concluded that the technique did not reduce oncological safety and was suitable for women who were not eligible for breast conserving therapy.
Dr Morrow warns: "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."
Dr Lesley Walker, director of cancer information at Cancer Research UK, said: "Breast cancer surgeons should always prioritise the best treatment options ahead of cosmetic considerations.
"Modern chemotherapy treatments have led to a significant reduction in the number of mastectomies carried out with more breast conserving surgery taking place. It's important that patients are fully informed of the risks and benefits of different procedures."