More on breast cancer guidelines
CMAJ 1998;158:1425
See response from: M. McGregor
The Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer should be complimented on these comprehensive and up-to-date guidelines to assist patients and physicians in reaching decisions about the treatment of breast cancer.
I found one glaring omission in the guidelines, however: the role of breast reconstruction in treatment. As a plastic surgeon, I find that some physicians and surgeons are uninformed or misinformed about the options available to women unable to undergo breast-conserving surgery. Even in the section on the "informed choice" between breast-conserving surgery and mastectomy in "Mastectomy or lumpectomy? The choice of operation for clinical stages I and II breast cancer" (CMAJ 1998;158[3 Suppl]:S1521 [full text / text complet]), there is no mention of discussing breast reconstruction with the patient and the role of such a discussion in a truly informed decision. I assume that the steering committee did not feel this was a subject that warranted inclusion. However, my experience with patients who have undergone breast reconstruction and even those who have simply discussed the possibility of this surgery in consultation indicates that they consider this an integral part of their treatment, both in a physical sense and in a psychosocial sense.
Stephen C. Brown, MD
Plastic and Cosmetic Surgeon
Briarwood Cosmetic Surgical Centre
Oakville, Ont.
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