COST-EFFECTIVE PREOPERATIVE EVALUATION, OPERATIVE TREATMENT, AND POSTOPERATIVE FOLLOW-UP IN THE BREAST CANCER PATIENT
Section snippets
PREOPERATIVE STRATEGIES
Previously, patients proven to have breast cancer were extensively worked up by routine blood tests and scans of bones, liver, lung, and even brain at the time of disease presentation in order to detect occult metastatic disease. Occasionally, some patients still may need such extensive pretreatment diagnostic efforts if they have an advanced primary breast cancer or suggestive symptoms. A summary of numerous studies26 indicates, however, that liver scans, bone scans, or extensive diagnostic
OPERATIVE STRATEGIES
The role of stereotactic biopsy of mammographically discovered lesions suspicious of cancer is as yet unclear, both from a surgical management as well as a cost point of view. Whether overall it merely adds another expensive step in the diagnostic process or truly saves resources is yet to be defined.
The initial therapeutic operative approach in breast cancer patients in the United States today should be a local anesthesia excision of a palpable mass that fulfills the requirements of a
ADJUVANT THERAPY STRATEGIES
The avoidance of radiation therapy after adequate local excision of selective small or well-differentiated invasive breast cancer detected mammographically can yield significant gains in reduced patient morbidity, increased patient comfort and satisfaction, and reduced cost at no sacrifice of effectiveness in cancer treatment and cure.5, 17 This is particularly to be appreciated when it is realized that the charges for a course of radiation therapy range from $12,000 to $18,000 or more in the
POSTOPERATIVE STRATEGIES
Postoperative management of patients with invasive and noninvasive breast cancer has undergone numerous re-evaluations during the past decade. It has been shown repeatedly that minimal testing following appropriate primary therapy is the most efficient management system.7 In the past, many patients were followed with routine bone scans, blood tests, chest radiographs, and CT scans. These tests are completely ineffective in changing ultimate survival and, therefore, should be abandoned.
SUMMARY
Although medical criteria based on retrospective and prospective studies form the basic foundation for the strategies enunciated in this article, efficiency in management and cost effectiveness follow because of the simplification that has been found to be appropriate by analyzing reports over the past decade and using common sense. In addition, the realization of the effectiveness of mammographic screening programs should encourage all surgeons to promote and practice yearly mammographic
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Address reprint requests to Blake Cady, MD, New England Deaconess Hospital, 110 Francis Street, Boston, MA 02215
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From New England Deaconess Hospital, Boston, Massachusetts