Update on Breast Cancer Treatment—More is Not Better!

One of the most significant advancements in breast cancer care has been the shift towards a more personalized approach to treatment. By identifying who truly needs aggressive therapy and who doesn’t, we can maximize the number of people who are cured while sparing others from unnecessary treatments that offer no benefit. This not only reduces side effects and complications for patients but also avoids unnecessary costs. Unfortunately, some patients, in wanting to “do everything,” end up receiving treatments that may not provide any additional benefit. Physicians may sometimes go along with this, leading to unnecessary and potentially harmful treatments that burden both the patient and the healthcare system.

To address this, the American Society of Breast Surgeons, the American Board of Internal Medicine, and Consumer Reports created the Choosing Wisely campaign. This initiative promotes open conversations between physicians and patients about choosing the most appropriate tests and treatments.

Today, more than 80 specialty societies participate in the Choosing Wisely campaign. The first breast cancer guidelines were published in 2016 and include recommendations such as:

• Avoid routine breast MRI for every new breast cancer diagnosis.

• Avoid routinely performing axillary lymph node dissection (removing many nodes in the armpit).

• Avoid genomic testing on every new cancer.

• Avoid re-excising a close but negative surgical margin.

• Avoid double mastectomy when cancer is present in only one breast.

• Avoid screening mammography in asymptomatic patients with normal exams who have a life expectancy of less than five years.

The latest guideline advises against axillary staging (sentinel lymph node biopsy) in women over 70 with favorable hormone-positive breast cancer.

Here are five essential questions to ask your doctor before any test, treatment, or procedure:

1. Do I really need this test or procedure?

2. What are the risks and side effects?

3. Are there simpler, safer options?

4. What happens if I don’t do anything?

5. How much will it cost, and will my insurance cover it?

   
   

For more information, visit ChoosingWisely.org. For specific breast cancer guidelines, visit BreastSurgeons.org/resources/choosing_wisely.