werner@aecom.UUCP (Craig Werner) (06/23/85)
The following study (of which I am quoting just the abstract) will probably be debated for years to come, so I thought some people on USENET might be interested, especially women ... [Notes: In the study below, Total Masectomy denotes what is also called Modified Radical Masectomy, Segmental Masectomy is also sometimes called Lumpectomy.] From the NEW ENGLAND JOURNAL OF MEDICINE Five-Year Results of a Randomized Clinical Trial Comparing Total Masectomy and Segmental Masectomy With or Without Radiation in the Treatment of Breast Cancer. In 1976, we began a randomized trial to evaluate breast conservation by a segmental masectomy in the treatment of stage I and II breast tumors 4 cm or smaller in size. The operation removes only sufficient tissue to ensure that margins of resected specimens are free of tumor. Women were randomly assigned to total masectomy, segmental masectomy alone, or segmental masectomy followed by breast irradiation. All patients had axillary disections, and patients with positive nodes received chemotherapy. Life table estimates based on data from 1,843 women indicated that treatment by segmental masectomy, with or without breast irradiation, resulted in disease-free, distant- disease-free, and overall survival at five years that was no worse than that after total breast removal. In fact, disease-free survival after segmental masectomy plus radiation was better than disease-free survival after total masectomy (P=.04), and overall survival after segmental masectomy, with or without radiation, was better than overall survival after total masectomy (P=.07 and P=.06 respectively). A total of 92.3% of women treated with radiation remained free of breast tumor at five years compared with 72.1% of those receiving no radiation (P<.001). Among patients with positive nodes, 97.9% of women treated with radiation remained tumor free (P<.001) although both groups received chemotherapy. We conclude that segmental mastectomy, followed by breast irradiation in all patients and adjuvant chemotherapy in women with positive nodes, is appropriate therapy for stage I and II breast timors 4 cm or smaller, provided that margins of resected specimens are free of tumor. (1985; 312:665-673) Bernard Fisher et al, National Surgical Adjuvant Breast Project Headquarters, Room 914, Scaife Hall, 3550 Terrace St., Pittsburg, PA 15261. [Translation and The bottom line: For small breast cancers - the best treatment is to remove just the part of breast that has the cancer, and then treat with Radiation Therapy. Therefore, it is no longer considered neccessary to remove the entire breast.] -- Craig Werner !philabs!aecom!werner "The world is just a straight man for you sometimes"
sophie@mnetor.UUCP (Sophie Quigley) (07/11/85)
> From the NEW ENGLAND JOURNAL OF MEDICINE > > In 1976, we began a randomized trial to evaluate breast > conservation by a segmental masectomy in the treatment of > stage I and II breast tumors 4 cm or smaller in size. The operation > removes only sufficient tissue to ensure that margins of resected > specimens are free of tumor. Women were randomly assigned to > total masectomy, segmental masectomy alone, or segmental > masectomy followed by breast irradiation. *randomly* assigned (!?!) outch!!! Did the patients know that their treatment was decided *randomly* ? Whatever happened to the hypocratic oath? couldn't they do this on monkeys or something? I don't know what other people think, but this sounds like wonderful grounds for malpractise suits. Could you please tell us where this kind of thing is going on so that I can make sure never to go there if I get breast cancer? -- Sophie Quigley {allegra|decvax|ihnp4|linus|watmath}!utzoo!mnetor!sophie
sophie@mnetor.UUCP (Sophie Quigley) (07/11/85)
OOps sorry about that. I just saw the address at the bottom.
--
Sophie Quigley
{allegra|decvax|ihnp4|linus|watmath}!utzoo!mnetor!sophiecat@tommif.UUCP (Catherine Mikkelsen) (07/15/85)
In article <1272@mnetor.UUCP>, sophie@mnetor.UUCP (Sophie Quigley) writes
about breast cancer and the treatment thereof.
There was an interesting article titled *Breast Cancer Hoax* in _Mother
Jones Magazine_ (May issue). The article was written by Grace Paley and
discussed at some great length the, ahem, interesting treatment trends for
breast cancer.
dum daa dum daa dum daa dum
Just when you thought it was safe to get back into society!!
Catherine Mikkelsen
decwrl!greipa!tommif!cathrs@homxb.UUCP (H.SILBIGER) (07/15/85)
While it seems objectionable and unfair to evaluate the effectiveness of medical treatments by assigning patients randomly to groups, there is no alternative if the evaluation is to be done correctly. While there were some previous claims that radical mastectomies were no better than lumpctomies, there was no proof, and thus the old treatment continued. Herman silbiger
oliver@unc.UUCP (Bill Oliver) (07/16/85)
In article <mnetor.1271> sophie@mnetor.UUCP (Sophie Quigley) writes: > >*randomly* assigned (!?!) outch!!! Did the patients know that their >treatment was decided *randomly* ? Whatever happened to the hypocratic >oath? couldn't they do this on monkeys or something? I don't know >what other people think, but this sounds like wonderful grounds for >malpractise suits. > >Could you please tell us where this kind of thing is going on so that I >can make sure never to go there if I get breast cancer? >-- >Sophie Quigley >{allegra|decvax|ihnp4|linus|watmath}!utzoo!mnetor!sophie I think this needs a little explanation. The methods by which an experimental protocol is put into practice and how patients are placed into treatment groups are very carefully thought out and the potential benefit and risk to the patient is examined. Generally speaking, patients are not put on therapeutic protocols which have not been evaluated in detailed animal studies or profoundly good epidemiological evidence. Following the animal studies, the experimental protocol is then brought before a board, usually consisting of physicians, clergy, government and advocate representatives, and frequently ethicists (here it is called the Human Experimentation Committee). The board then evaluates the possible benefit and risk to the patients involved with the protocol. For instance, in the protocol above, none of the therapies mentioned were considered bad therapies, and in fact, there were no good criteria for desiring one above the other for breast cancer as presented in the article, i.e. without regard to histologic type (there are some good arguments against the way the protocol is presented in the NEJM, but that is not germaine here). If you were to go to a private practice surgeon, the type of therapy you would receive would depend largely on his individual background (what they did back at the mecca where he was trained, what articles he had read recently, what he decided to try because of a recent symposium, what he had been successful with in the past, etc.), and not on a proven best therapy - because any one of a number of different therapies are accepted as equally valid. In medicine, there is frequently not a single best way of doing something. Thus, the patient has little to lose by being in the protocol. The surgeon firmly believes that a lumpectomy is as good as a modified radical, and would not suggest the trials unless both he and the board felt there was good evidence. If, in fact, a distinction in outcome bacomes quickly and dramatically apparent, the physician is ethically bound to discontinue the protocol, as has occasionally happened in the past. Once the protocol is accepted as ethical and of scientific worth, the patients are inevitably given a detailed description of the protocol (unless the description itself may affect the outcome as in some psychiatric trials, or unless the educational status of the patient precludes a detailed description - in any case a valid if not detailed description is made). The patient then decides whether or not to become part of the protocol. In the case of the above protocol, the patients had the choice of demanding a therapy of their choice, or of being a part of the study. Believe it or not, a large number of patients are quite willing to aid in advancing medical knowledge. I have been involved in a number of treatment protocols, and have uniformly been impressed with the generally intelligent, open, and agreeable attitude of most patients. Physicians in tertiary care facilities generally don`t have to sneak anything by a patient because most patients have pretty good heads on their shoulders. If they don`t, then they will probably not be compliant and would screw up the protocol if they were placed on it. What you really don`t want is a sullen, suspicious, or dishonest patient on a protocol - you have no idea where you stand, they frequently do unusually poorly no matter how hard you try, and then they sue. As far as being assigned randomly goes, if you use a bias of any sort then the experiment is compromised. Even self-choice would leave a bias. I suspect that younger, healthier women would tend to opt for more cosmetically pleasing surgery and would bias the population. I don`t know however, I am drawing from my experience with offering men the option of castration for therapy in prostatic carcinoma. The older the men were, the less they resisted the idea. I am presently involved with a study of Ewing`s sarcoma, a bone tumor of children. The tumor is rare, and it would be virtually impossible to figure out a way to treat it without a large number of hospitals pooling their cases and using strict protocols to be able to compare treatment methods. As the years have passed, fairly startling conclusions have been drawn about treatment of the disease - many of which may well save young patients the pain and terrific discomfort which sometimes accompanies aggressive surgical and chemotherapy - therapies which, while discomforting, are increasingly bringing about cures when the correct patient population is identified. As each year passes, more tumors are going the way of Hodgkin`s disease - from 95% mortality to 85% survival (these number are +/- about 10%. I am not near my references now and am quoting from my head - a notoriously bad place from which to dredge numbers). As an aside, the same committee must review all experiments which use human tissue from any source. It is impossible, for instance to do a casual prospective study of biopsy, autopsy, or surgical tissues which does not use procedures which would have been performed anyway (in other words, you can make a microscopic slide of the tissue and look at it for some experimental reason only if you were making the slide for some bona fide therapeutic purpose) without first going through the committee - the bane of the agressive young resident. This is not to say, of course, that poor protocols have not existed; they are, however, by far the exception in terms of patient rights and not the rule. They also tend to be rather old. Every time I hear someone berate experimental protocols because of weird things done to prisoners in the 20s - 40s, I must point out that this was some time ago. Experimental medicine, like all society, is not the same in the 80s as it was in the 40s. Bill Oliver standard disclaimer
stryker@dicomed.UUCP (d. j. stryker) (07/16/85)
In article <673@homxb.UUCP> hrs@homxb.UUCP (H.SILBIGER) writes: >While it seems objectionable and unfair to evaluate >the effectiveness of medical treatments by assigning >patients randomly to groups, there is no alternative >if the evaluation is to be done correctly. > >While there were some previous claims that radical mastectomies >were no better than lumpctomies, there was no proof, and >thus the old treatment continued. > >Herman silbiger There is no excuse for drivel such as this. It SHOULD BE a doctor's responsibility to inform his patients of their choices. What do you mean 'there is no alternative to randomly assigning treatment? If the patients were informed in advance that they were being assigned a random treatment, and were made aware of what the differences in outcome of the dice roll could mean to them, then it is acceptable. If not, these so called doctors should promptly roll an unbiased die, and if it comes up 1-5 their breasts should be removed. If it comes up 6 ... well, use your imagination. Don p.s. The original posting does't tell whether or not patients were informed that they were to recieve a random treatment. Were they?
hollombe@ttidcc.UUCP (The Polymath) (07/17/85)
In article <1271@mnetor.UUCP> sophie@mnetor.UUCP (Sophie Quigley) writes: >> ... Women were randomly assigned to >> total masectomy, segmental masectomy alone, or segmental >> masectomy followed by breast irradiation. > >*randomly* assigned (!?!) outch!!! Did the patients know that their >treatment was decided *randomly* ? Whatever happened to the hypocratic >oath? couldn't they do this on monkeys or something? I don't know >what other people think, but this sounds like wonderful grounds for >malpractise suits. This is standard experimental procedure. Assuming it was done by a reputable institution, the women involved would have known they were part of an experiment and probably signed a consent form stating they understood the nature of the situation. Note that _all_ of the treatments involved have been used in the past to treat breast cancer. The purpose of the experiment was to determine if any one of them was more effective than the others. Without the results of this experiment it's likely that total mastectomy would have continued as the treatment of choice for breast cancer. Given the results, the women in the total mastectomy group of the experiment may be among the last to undergo such treatment. I see nothing to worry Hippocrates here, or to justify a malpractice suit. -_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_ The Polymath (aka: Jerry Hollombe) Citicorp TTI Common Sense is what tells you that a ten 3100 Ocean Park Blvd. pound weight falls ten times as fast as a Santa Monica, CA 90405 one pound weight. (213) 450-9111, ext. 2483 {philabs,randvax,trwrb,vortex}!ttidca!ttidcc!hollombe
seifert@hammer.UUCP (Snoopy) (07/18/85)
In article <602@unc.UUCP> oliver@unc.UUCP (Bill Oliver) writes: > I suspect that younger, healthier women would >tend to opt for more cosmetically pleasing surgery and would >bias the population. "cosmetically pleasing" ? This is truely warped. Someone objects to having entire, functional parts of their body whacked off, when a much less radical option is available, and you accuse them of only being worried about cosmetics? I for one am grossly offended by this attitude. the Bavarian Beagle tektronix!hammer!seifert
bob@cadovax.UUCP (Bob "Kat" Kaplan) (07/18/85)
In article <116@tommif.UUCP> cat@tommif.UUCP (Catherine Mikkelsen) writes: >There was an interesting article titled *Breast Cancer Hoax* in _Mother >Jones Magazine_ (May issue). The article was written by Grace Paley and Actually, the article was titled "An Indecent Proposal" and was written by Jeremy Weir Alderson, not by Grace Paley. Grace Paley, the noted fiction writer, did have a short story "Telling" published in that issue, however. -- Bob Kaplan "Ilo Shaka. I Olimo Shando. Shanda Lamoshi Kando. Hopa Bia Shata Mahanda."
sophie@mnetor.UUCP (Sophie Quigley) (07/19/85)
About assigning patients treatments for breast cancer randomly: > > This is standard experimental procedure. Assuming it was done by a > reputable institution, the women involved would have known they were part > of an experiment and probably signed a consent form stating they understood > the nature of the situation. > > Note that _all_ of the treatments involved have been used in the past to > treat breast cancer. The purpose of the experiment was to determine if any > one of them was more effective than the others. Without the results of > this experiment it's likely that total mastectomy would have continued as > the treatment of choice for breast cancer. Given the results, the women in > the total mastectomy group of the experiment may be among the last to > undergo such treatment. > > I see nothing to worry Hippocrates here, or to justify a malpractice suit. > -_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_ > The Polymath (aka: Jerry Hollombe) Well, maybe I should have made my point clearer. It is my impression that most people have opinions on things, so I would assume that most doctors have an opinion on what they *think* is the best treatment for a particular disease for a particular person. Therefore if they are not willing to provide what they think is the best treatment, then in my opinion, they are not doing the best they can. So, doctors who encourage their patients to participate in such a study know that since treatments are assigned randomly, there is a chance that their patients will not be given as good a care as they might have given them had they done what they thought was best. This is what I objected to. Of course doctors who truly have no opinion on the matter are doing their best by encouraging their patients to participate in such a study, but how many doctors with any kind of experience truly have no opinion? Maybe I should emphasise that I am talking about good intentions here rather than success. It is quite possible that doctors might prefer a particular treatment which is not necessarily the best, so that their patients would be better off being assigned treatments randomly, but I think that in this case, those doctors still have failed their patients by not insisting on giving them what they think is the best treatment. Before I get flamed into hell for this, let me add that I do not believe that it is up to doctors to decide what their patients should do, but it is their responsibility to inform their patients about all the available treatments and their advantages and disadvantages, and then let their patients decide for themselves. *** REPLACE THIS LINE WITH YOUR MESSAGE *** -- Sophie Quigley {allegra|decvax|ihnp4|linus|watmath}!utzoo!mnetor!sophie
oliver@unc.UUCP (Bill Oliver) (07/21/85)
In article <hammer.1390> seifert@hammer.UUCP (Snoopy) writes: >In article <602@unc.UUCP> oliver@unc.UUCP (Bill Oliver) writes: >> I suspect that younger, healthier women would >>tend to opt for more cosmetically pleasing surgery and would >>bias the population. > >"cosmetically pleasing" ? This is truely warped. Someone objects >to having entire, functional parts of their body whacked off, when >a much less radical option is available, and you accuse them of >only being worried about cosmetics? I for one am grossly offended >by this attitude. > >the Bavarian Beagle >tektronix!hammer!seifert I accuse no one of anything. You must understand that it is you, not I who denigrates the importance of the cosmetic results of surgery. To have restored the elephant man to relatively normal facial features (which, by the way, is now frequently practical), to restore a face following severe trauma, to preserve or restore the appearance of a breast through specific surgical intervention are all cosmetic procedures. This does not mean that they are not important; cosmetic surgery can transform a life. It is my experience, which while somewhat limited is not negligible, that many women who are contemplating a mastectomy are in fact very concerned about how they will appear in clothing, in a bathing suit, to their lovers. This is not a question of functionality. The women are no more concerned about losing one half of their potential for lactation than a woman contemplating a cholecystectomy is concerned about a decrease in her ability to store bile. A woman`s breasts are often important for her self-image, and that image is more frequently associated with the appearance of the breasts than with their function. That, by definition, is cosmetic; it is by no means trivial. It is possible, in many instances, to restore much of the visual and even external tactile appearance of a breast. In some instances, it is feasable to transplant the nipple and areola to a secondary site and then re-implant it onto the restructured breast. It is also my experience that younger women are more concerned about the appearance of their breasts than are older women, though by that I do not wish to imply that older women are not seriously concerned. I further maintain that my analogy to castration is fairly apt. Just as women are concerned about "having entire, functioning parts of their body whacked off", so are young men frequently concerned about the loss of a testis as occasionally occurs with trauma or malignancy. In fact, prosthetic (nonfunctioning) prostheses are available for implantation in the case of a man who suffers severe problems of self-image due to the loss of one or both testes. It is also my experience that younger men are more concerned about the loss of a testis than are older men, though by that I do not wish to imply that older men are not seriously concerned. My purpose in the statment you object to was to illustrate why self-choice was not an acceptable alternative to random assignment to treatment groups. Perhaps my desire not to be flippant when discussing the topic lead to a surfeit of euphemisms. If so, I apologize. In the future I shall be more explicit. Bill Oliver
fsks@unc.UUCP (Frank Silbermann) (07/21/85)
In article <602@unc.UUCP> oliver@unc.UUCP (Bill Oliver) writes: >>> I suspect that younger, healthier women would tend to opt >>>for more cosmetically pleasing surgery and would bias the population. >In article <hammer.1390> seifert@hammer.UUCP (Snoopy) writes: >> "cosmetically pleasing" ? This is truely warped. >>Someone objects to having entire, functional parts of their body >>whacked off, when a much less radical option is available, >>and you accuse them of only being worried about cosmetics? >>I for one am grossly offended by this attitude. In article <unc.647> oliver@unc.UUCP (Bill Oliver) writes: > This is not a question of functionality. The women are no more >concerned about losing one half of their potential for lactation >than a woman contemplating a cholecystectomy is concerned about >a decrease in her ability to store bile. You are forgetting that radical masectomy ALSO removes a great deal of muscle tissue underneath the breast. Women who receive this treatment lose a great deal of strength and functionality in the respective arm. Furthermore, the woman's weight is no longer balanced across her spine. This can eventually lead to lower back pain. Frank Silbermann
oliver@unc.UUCP (Bill Oliver) (07/22/85)
In article <unc.1> fsks@unc.UUCP (Frank Silbermann) writes: >In article <unc.647> oliver@unc.UUCP (Bill Oliver) writes: >> This is not a question of functionality. The women are no more >>concerned about losing one half of their potential for lactation >>than a woman contemplating a cholecystectomy is concerned about >>a decrease in her ability to store bile. > >You are forgetting that radical masectomy ALSO removes a great deal >of muscle tissue underneath the breast. Women who receive this treatment >lose a great deal of strength and functionality in the respective arm. >Furthermore, the woman's weight is no longer balanced across her spine. >This can eventually lead to lower back pain. > > Frank Silbermann On the contrary, I am aware of the morbidity associated with a radical mastectomy. I must remind you that the original posting was a speculation on why random assignment to treatment protocols is a necessary part of an experimental protocol. My response was in reply to the accusattion that I was being callous in stating that cosmetic results were important to younger women. I am making a statement about the primary concerns of a women when faced with the possibility of losing a breast. Weakness of the arm, lymphedema, hypesthesia/paresthesia, and imbalance are important, but are less encountered with modern therapies, and can be dealt with more easily in day to day life than an assault on a woman`s self-image. Radical mastectomies , while still claiming some adherents, are much more rarely performed today than 10 years ago, and a more approriate ruler is the modified radical, in which the pectoralis major (the loss of which causes the arm weakness) is preserved. In discussing any subject in a forum where one wants to limit the length of an article to a manageable size, it is necessary to make some assumptions. One assumption I made was that the woman was contemplating a lumpectomy versus modified radical or simple mastectomy, not the relatively obsolete full radical mastectomy. The second was that I should stick as closely as possible to my point. Still, my purpose is not to write a review on therapies for breast malignancy. It is to explain why random assignments are made and to show that cosmetic results are nontrivial. sigh, Bill Oliver
mmar@sphinx.UChicago.UUCP (Mitchell Marks) (07/24/85)
> My purpose in the statment you object to was to illustrate > why self-choice was not an acceptable alternative to > random assignment to treatment groups. > > Bill Oliver Before anyone misunderstands and leaps on this, note that Bill Oliver was surely talking about the situation *after* the patient has elected to participate in the study. In any clinical study (with human subjects), the choice of whether or not to participate has to be offered first. The strictures against self-choice apply to assigning those who have already elected to participate into the various study groups. -- -- Mitch Marks @ UChicago ...ihnp4!gargoyle!sphinx!mmar
desjardins@h-sc1.UUCP (marie desjardins) (07/24/85)
> > Well, maybe I should have made my point clearer. It is my impression > that most people have opinions on things, so I would assume that most > doctors have an opinion on what they *think* is the best treatment for > a particular disease for a particular person. I don't think this is necessarily true. There are almost certainly tradeoffs to every treatment, and in this case, the treatments are still at least somewhat in the experimental phase (or they wouldn't be running experiments using them!), so some of the tradeoffs are unknown. What's the best computer language? Perhaps for a particular application, a LISP program would be the most natural, but would be twice as slow as a C program to do the same thing. Things are never black in white. In medicine I would think this is at least, if not more, true than in most other areas of life. What's your favorite brand of hot dogs? (Me, I just buy the cheapest one, and if two are the same price, I choose randomly.) marie desjardins park
sck@elsie.UUCP (Steve Kaufman) (07/24/85)
In article <1400@mnetor.UUCP>, sophie@mnetor.UUCP (Sophie Quigley) writes: > ... most people have opinions on things, so I would assume that most > doctors have an opinion on what they *think* is the best treatment for > a particular disease for a particular person. > ... So, doctors who > encourage their patients to participate in such a study know that since > treatments are assigned randomly, there is a chance that their patients > will not be given as good a care as they might have given them had they > done what they thought was best. > With apologies to those who caught this the first time around, I think it's appropriate to re-post what I submitted 2 months ago on this subject (a quote from a recent book on clinical trials): "Presumably, the reason that a clinical trial is being considered at all is that there is uncertainty about the potential benefits of a new intervention. If an investigator believes --for whatever reason-- that the new intervention is more beneficial or harmful than the old, he should not participate in the trial. If, on the other hand, he has sufficient doubt about which intervention is better, then he is ethically justified in participating in a randomized clinical trial to settle the question. ... under these circumstances, randomization is a more ethical way of practicing medicine than the routine prescribing of medication or therapy that has never been proven to be beneficial ... and could possibly be harmful." (pp. 31-2) "Of course, some results, such as the effectiveness of penicillin in pneumococcal pneumonia, are so highly dramatic than no comparison group is needed. Successful results of this magnitude, however, are rare." (p. 29) ----excerpted from _Fundamentals_of_Clinical_Trials_ by L. M. Friedman, C. D. Furberg, & D. L. DeMets (Wright, PSG, Inc: 1982 [I understand there's a 1985 edition out now but haven't seen it yet])
seshadri@t12tst.UUCP (Raghavan Seshadri) (07/25/85)
> From: cat@tommif.UUCP (Catherine Mikkelsen) > > There was an interesting article titled *Breast Cancer Hoax* in _Mother > Jones Magazine_ (May issue). The article was written by Grace Paley and > discussed at some great length the, ahem, interesting treatment trends for > breast cancer. O K ,now you have piqued my curiosity.Can you mention some of these interesting things ? -- Raghu Seshadri
jeff@rtech.UUCP (Jeff Lichtman) (07/25/85)
> About assigning patients treatments for breast cancer randomly: > > > > This is standard experimental procedure.... > > > > The Polymath (aka: Jerry Hollombe) > > It is my impression > that most people have opinions on things, so I would assume that most > doctors have an opinion on what they *think* is the best treatment for > a particular disease for a particular person. Therefore if they are > not willing to provide what they think is the best treatment, then in > my opinion, they are not doing the best they can. > ... > Before I get flamed into hell for this, let me add that I do not believe > that it is up to doctors to decide what their patients should do, but > it is their responsibility to inform their patients about all the > available treatments and their advantages and disadvantages, and then > let their patients decide for themselves. > > Sophie Quigley I'm sure that most doctors have opinions on which treatments should be used for particular diseases. However, they also have the responsibility to make sure that their opinions are based on fact. For decades the most common treatment for breast cancer was radical mastectomy; subsequent research has shown that it is not the best treatment in most cases. It is my understanding that radical mastectomy was the first successful treatment for breast cancer, but no research was done originally to show that it was the best or only way. For a long time doctors used this technique because "that is the way it is done." I agree that doctors should use their best judgement, and keep their patients informed. But they should also be sure that their "best judgement" is really best. This can be done only with research. -- Jeff Lichtman at rtech (Relational Technology, Inc.) aka Swazoo Koolak {amdahl, sun}!rtech!jeff {ucbvax, decvax}!mtxinu!rtech!jeff
greenber@timeinc.UUCP (Ross M. Greenberg) (07/27/85)
This months issue of _Scientific_American_ has, in their Science and
the Citizen section a short piece about mastectomy versus lumpectomy.
Generally speaking, it indicates that:
1) Survival of 80% for lumpectomy vs. 70% for mastectomy (after
5 years)
2) Cancer free: 70% lumpectomy, 65% mastectomy in areas affected,
about even in total body
Only Stage I and/or Stage II.
Interesting stuff!
--
------------------------------------------------------------------
Ross M. Greenberg @ Time Inc, New York
--------->{vax135 | ihnp4}!timeinc!greenber<---------
I highly doubt that Time Inc. would make me their spokesperson.
----
"I saw _Lassie_. It took me four shows to figure out why the hairy kid
never spoke. I mean, he could roll over and all that, but did that
deserve a series?"