Minimally Invasive Surgery for Breast Cancer Raising Safety Concerns

Minimally invasive breast surgery for beast cancer may be trading better cosmetic outcomes for worse rates of cure, according to a recently published editorial.

Monica Morrow, M.D., chief of the breast service at Memorial Sloan-Kettering Cancer Center (MSKCC, New York, NY, USA) warns that over the past 30 years, surgery for breast cancer has become increasingly devoted to improving cosmetic outcomes. According to Dr. Morrow, a review of the evidence reveals that the oncological safety of new techniques such as oncoplastic and endoscopic surgery, which involve minimal skin incision, are often not being evaluated thoroughly. Dr. Morrow is also concerned that 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. She also points out that the developing fields of oncoplastic surgery and minimally invasive breast surgery require rigorous assessment of patient reported outcomes to ensure that new procedures actually improve outcomes that are important to patients. The editorial was published early online on February 19, 2009, in the British Medical Journal (BMJ).

"The local treatment of breast cancer is based on the results of numerous high quality clinical trials and is therefore a model for evidence based care. As we attempt to advance from good to great cosmetic outcomes it is important that we remember this,” said Dr. Morrow. "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.”

Minimally invasive breast surgery includes techniques of breast conserving surgery, mastectomy, sentinel node biopsy, and axillary dissection.

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Memorial Sloan-Kettering Cancer Center