Seven Common Cancer Surgery Practices That Should Stop

ACS and CoC Issue Lists

Nick Mulcahy

September 09, 2013

Seven clinical practices have been identified that are related to cancer surgery but are not supported by evidence and should no longer be routinely used, according to the American College of Surgeons (ACS) and its affiliated panel, the Commission on Cancer.

The list has been issued as part of the Choosing Wisely campaign, an initiative of the American Board of Internal Medicine (ABIM) Foundation.

The campaign dates from 2010, when Howard Brody, MD, PhD, professor of family medicine at the University of Texas in Galveston, challenged each medical specialty to take a critical look at its field and identify practices that are commonly performed despite a lack of evidence (N Engl J Med. 2010;362:283-285).

Since then, a variety of medical organizations have issued lists, which include a set of 5 inadvisable cancer practices from the American Society of Clinical Oncology.

A cavalcade of organizations will issue lists this fall, including a number of cancer-related groups such as the American Society for Radiation Oncology, the Society of Gynecologic Oncology, the American Society of Hematology, and the American Society for Clinical Oncology. Some of the organizations will be issuing recommendations for the second or even third time.

The ACS list can be used to "support conversations between patients and physicians about what care is really necessary," according to a press statement.

"This initiative will help provide cancer patients with a highly credible resource to obtain reliable information when discussing certain aspects of their care with their physicians," said David P. Winchester, MD, medical director of the ACS Cancer Programs.

"The American College of Surgeons and the Commission on Cancer have shown tremendous leadership by releasing its list of tests and procedures they say are commonly done in surgery and surgical oncology, but aren't always necessary," said Richard J. Baron, MD, president and CEO of the ABIM Foundation.

The content of the Choosing Wisely lists is intended to reduce waste and overuse in the American healthcare system, Dr. Baron explained.

The campaign also aims to reach consumers nationwide through a variety of partnerships, including one with Consumer Reports, which is issuing patient-friendly resources.

The Lists

The ACS has issued the following 2 recommendations:

  • Do not perform axillary lymph node dissection for clinical stage I or II breast cancer with clinically negative lymph nodes without attempting sentinel node biopsy.

  • Avoid colorectal cancer screening tests for asymptomatic patients with a life expectancy of less than 10 years and no family or personal history of colorectal neoplasia.

In addition, the Commission on Cancer has issued the following 5 recommendations:

  • Do not perform surgery to remove a breast lump for suspicious findings unless a needle biopsy cannot be done.

  • Do not initiate surveillance testing after cancer treatment without providing the patient with a survivorship care plan.

  • Do not use surgery as the initial treatment without considering whether presurgical (neoadjuvant) systemic and/or radiation therapy can be effective at improving local cancer control, quality of life, or survival.

  • Do not perform major abdominal surgery or thoracic surgery without a pathway or standard protocol for postoperative pain control and pneumonia prevention.

  • Do not initiate cancer treatment without defining the extent of the cancer (through clinical staging) and discussing the intent of treatment with the patient.

The supporting literature citations and expanded explanations for the ACS and Commission on Cancer lists are posted on the ACS Web site and on the Choosing Wisely Web site.

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