A partial mastectomy for breast cancer--long advocated as less disfiguring and psychologically traumatic than removal of the entire breast--is appropriate for 80% of patients, concludes a new study based on the longest follow-up yet described.
But resistance among doctors who cling to total mastectomy as their treatment of choice still inhibits wider reliance on the less disfiguring procedure, contends Dr. John Stehlin, a Houston cancer specialist and a pioneer of the partial mastectomy
In 1985, a National Cancer Institute follow-up study examining the success of total and partial mastectomy in women three years after treatment concluded that the less disfiguring technique was just as good as total mastectomy for a variety of patients. In the new study, published in the journal Surgery, Gynecology and Obstetrics, 334 patients followed after treatment for an average of five years had survival rates of 87%, with 10-year survivals of 64%.
Better Mental Health
"We believe that this is an appropriate therapy for approximately 80% of the patients with operable tumors," the Stehlin team reported. "The survival rates will not be improved by choosing a more radical operation."
In a telephone interview, however, Stehlin said many physicians continue to resist the more conservative surgery. "You will never believe the difference in the patient's morale with the partial," he said. "But the physician doesn't want to change. They're concerned about a procedure (the radical mastectomy) that has become the bible."
The procedure advocated by Stehlin removes far less breast tissue than a total mastectomy, but more than in a so-called lumpectomy, in which only a small area around the tumor is affected. His technique is accompanied by dissection of lymph nodes in the armpit to check for spread of cancer and by radiation therapy.
Smokers' Gum Program
With increasing numbers of companies moving to ban smoking entirely from their premises, workers increasingly face the challenge of coping with their smoking urges during working hours when lighting up is verboten .
A new study from the University of London concludes that nicotine chewing gum--already a staple in some smoking cessation programs--may be especially useful as a way to forestall tobacco cravings in the workplace. The gum doesn't work very well, but even its modest effect--12% of workers using it stayed tobacco-free versus just 2% of a control group that did not participate--makes trying it worthwhile, the researchers reported in the American Journal of Public Health.
The study focused on 334 smokers at a London office. "Our findings suggest that workplace smoking cessation programs based on nicotine chewing gum are practicable and worthwhile," the researchers concluded.