Breast cancer and informed consent

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For nearly a century radical mastectomy, with or without irradiation, has been the accepted treatment of operable cancer of the breast. In the United States, although not in England or Scandinavia, it is still employed in the majority of patients with operable breast cancers. With such overwhelming endorsement from the surgeons of the United States the status of this operation would appear to be established beyond question, at least from the standpoint of customary practice. Yet recent developments in the now controversial field of the treatment of breast cancer raise the question of whether or not the patients who submit to radical mastectomy are doing so with informed consent. The following are some of the questions that might be asked.

Are patients with breast cancer informed by their surgeons that randomized studies in England have shown that the survival rate after simple mastectomy and irradiation is just as high as after radical mastectomy and irradiation?1 Are they told that a randomized Scandinavian study has shown that survival rates, at 5 and 10 years, are the same after simple mastectomy and irradiation and after ultraradical operations?2 Have they been informed that there are several series of patients,3 including one controlled study,4 in which local excision of breast cancers followed by irradiation has given results equal to or perhaps superior to those following radical mastectomy? Have they been informed that in women with small, peripherally located cancers, wide local excision without irradiation has given results that are comparable in both survival and . . .



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