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IOM Cancer Report Highlights Harmful Care

Cheryl Clark, for HealthLeaders Media, September 12, 2013

"I'll give you one example," she says. "If I'm a general surgeon, I trained and learned how to do mastectomies, but maybe I was never trained in sentinel node biopsies. Maybe I still do excisional biopsies of the breast, when a needle biopsy is the right thing to do. If so, I'm not offering standard of care."

But appropriate needle biopsies "are not what's happening in many areas around the country; a lot of women are having unnecessary procedures. Instead of having the core needle biopsy, they're getting excisions."

Here's another, she says. "We shouldn't be doing colorectal cancer screening on patients with less than a 10-year life expectancy, but we do."

And mammograms aren't supposed to be given to women over 75, because the risks outweigh the benefits. But they are.

Just this week, the American College of Surgeons and its Commission on Cancer released its five picks for the Choosing Wisely campaign, in which 50 professional medical groups list types of common care that patients and doctors should avoid.

Among their picks were the two Ganz mentioned:

  • "Don't perform axillary lymph node dissection for clinical stages I and II breast cancer with clinically negative lymph nodes without attempting sentinel node biopsy,"
  • "Avoid colorectal cancer screening tests on asymptomatic patients with a life expectancy of less than ten years and no family or personal history of colorectal neoplasia.
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