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Intensive treatments for breast cancer

We do things because…

“We [doctors] do things because other doctors do so and we don’t want to be different.”

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The therapies advocated for breast cancer – so often in the news – provide some especially valuable lessons about the dangers of assuming that more intensive treatments are necessarily beneficial.
Throughout the 20th century and into the 21st, women with breast cancer have both demanded and endured some exceedingly brutal and distressing treatments. Some of these treatments – surgical and medical – far exceeded what was actually required to tackle the disease. But they were also unquestionably popular with some patients as well as their doctors. Patients were convinced that the more radical or toxic the therapy, the more likely the disease would be ‘conquered’.

It has taken doctors and patients who have been prepared to challenge orthodox views of the condition many years to begin to turn the tide of mistaken belief. They not only had to produce reliable evidence to banish the myth that ‘more is better’, but also suffer the ridicule of their peers and the resistance of eminent practitioners.

Drastic treatment is not always best

Randomized trials comparing drastic treatment with less drastic treatment are vital in order to protect patients from needless risk.

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Today, fear, coupled with the belief that more must be better, still drives treatment choices, even when there is no evidence of benefit over simpler approaches, and where known harms are considerable, including the possibility of death from the treatment itself.

For example, this mindset still prompts some patients and their doctors to opt for ‘traditional’ mutilating surgery. Others choose high-dose chemotherapy, with its well known unpleasant and painful side-effects, or Herceptin, which can cause serious heart problems, even when simpler treatments would be sufficient. How can this be?

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