Friday, March 31, 2017

A Recurring US Surgical Policy Question: What To Make Of The TRIPLING Of A Certain Invasive Surgery, With No Survival Benefit?

If memory serves, I haven't blogged on this oncology-related (and thus tangentially-Merck related) topic before -- but I have followed this clearly disturbing trend, in the peer-reviewed literature, for almost a decade now. And while it crosses several other diseases and conditions -- is perhaps nowhere more striking than in breast cancer.

Do read this longish MSM article, but understand that many technical nuances are lost in MSM reporting. Even so, it is alarming:

. . . .Double mastectomies tripled in 10 years. . . .

Sabel and his colleagues found in a separate study that the percentage of women who were eligible for lumpectomies but opted for double mastectomies rose between 2000 and 2012. The study was published in The Breast Journal last year.

Another study, published last year in the journal Annals of Surgery, found that the use of CPM overall more than tripled in the United States between 2002 and 2012, despite a lack of evidence that the procedure offers a survival benefit.

"Further examination on how to optimally counsel women about surgical options is warranted," the authors of that study wrote. . . .

"The numbers are staggering," Axelrod said. "In New York, for instance, which is where I practice, 11% of women in the early years had contralateral prophylactic mastectomy, which then rose to 28% in the later years," she said. "It's really shocking to see that dramatic of an increase."

The trend appeared to continue across the East Coast. Axelrod pointed to Virginia, where 9.8% of younger women underwent CPMs between 2004 and 2006 and 32.2% between 2010 and 2012. In Rhode Island, 7.6% rose to 25.8%, and in West Virginia, 6% rose to 26.4%. . . . .

The above-described effect is quite-pronounced, in Colorado and the Midwest, as well. What then should be done? More CME, so that the oncologists and family doctors more forcefully counsel women facing what are often very tough choices? I am open to all ideas, but both the cost to patient psychological well-being, and to the delivery system overall is large -- and accelerating -- for no discernible scientific reason.

I'll ponder that, over my quiet long weekend, with a sweet infant in tow. . . . Onward.


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