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Dare to think about doing less

So, more is not always better – and this message remains important. Today, in women with metastatic (widespread) breast cancer, there is considerable enthusiasm for treatments such as Herceptin. Yet, at best, Herceptin offers these patients a small chance of a longer life – measured sometimes only in days or weeks – at the expense of serious side effects, or sometimes even death from the treatment itself. [12,13]

The classical radical mastectomy

The radical mastectomy, devised in the late 19th century by William Halsted, was the most commonly performed operation for breast cancer until the third quarter of the 20th century.

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This tendency to over-treat is also evident at the other end of the breast cancer spectrum. For example, excessive and often unnecessary treatments have been used in women with precancerous conditions such as ductal carcinoma in situ (DCIS) detected by breast screening, when DCIS might never go on to cause a woman a problem in her lifetime if left untreated.

Meanwhile, the need for routine surgery to remove lymph nodes in the armpit, which risks unpleasant complications affecting the arm such as lymphoedema, is being increasingly challenged, since its addition to other treatments does not seem to improve survival. [14]

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Key point

  • More intensive treatment is not necessarily beneficial, and can sometimes do more harm than good.

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