Skip to main content

Advertisement

Log in

The Ethics of Breast Surgery

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Breast surgery has evolved as a subspecialty of general surgery and requires a working knowledge of benign and malignant diseases, surgical techniques, shared decision-making with patients, collaboration with a multi-disciplinary team, and a basic foundation in surgical ethics. Ethics is defined as the practice of analyzing, evaluating, and promoting best conduct based upon available standards. As new information is obtained or as cultural values change, best conduct may be re-defined. In 2014, the Ethics Committee of the ASBrS acknowledged numerous ethical issues, specific to the practice of breast surgery. This independent review of ethical concerns was created by the Ethics Committee to provide a resource for ASBrS members as well as other surgeons who perform breast surgery. In this review, the professional, clinical, research and technology considerations that breast surgeons face are reviewed with guidelines for ethical physician behavior.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Andersson GB, Chapman JR, Dekutoski MB, et al. Do no harm: the balance of “beneficence” and “non-maleficence.” Spine. 2010;35(suppl 9):S2–8.

    Article  PubMed  Google Scholar 

  2. Rosenthal, Angelos P, Cooper DS, et al. Clinical and professional ethics guidelines for the practice of thyroidology. Thyroid. 2013;23:1203–10.

  3. Rosenthal MS. Ethical issues in the management of thyroid disease. Endocrinol Metab Clin North Am. 2014;43:545–64.

    Article  PubMed  Google Scholar 

  4. University of Ottawa medical curriculum: Basic Ethical Principles. Basic Concepts in Medical Ethics page. Society, the Individual, and Medicine website. http://www.med.uottawa.ca/sim/data/Ethics_e.htm. Accessed 1 Dec 2014.

  5. McCormick TR. Principles of bioethics. [University of Washington School of Medicine Department of Bioethics & Humanities Ethics in Medicine website, Bioethics Tools] 2013 (last modified October 1, 2013). https://depts.washington.edu/bioethx/tools/princpl.html. Accessed 1 Dec 2014.

  6. Adedeji S, Sokol DK, Palser T, McKneally M. Ethics of surgical complications. World J Surg. 2009;33:732–7.

    Article  PubMed  Google Scholar 

  7. Loewenstein G. Projection bias in medical decision making. Med Decision Making. 2005;25:96–105.

    Article  Google Scholar 

  8. Langstein HN, Cheng MH, Singletary SE, et al. Breast cancer recurrence after immediate reconstruction: patterns and significance. Plast Reconstr Surg. 2003;111;712–20.

    Article  PubMed  Google Scholar 

  9. Kroll SS, Schusterman MA, Tadjalli HE, Singletary SE, Ames FC. Risk of recurrence after treatment of early breast cancer with skin-sparing mastectomy. Ann Surg Oncol. 1997;4:193–7.

    Article  CAS  PubMed  Google Scholar 

  10. Foster RD, Esserman LJ, Anthony JP, Hwang ES, Do H. Skin sparing mastectomy and immediate breast reconstruction: a prospective cohort study for the treatment of advanced stages of breast carcinoma. Ann Surg Oncol. 2002;9:462–6.

    Article  PubMed  Google Scholar 

  11. National Accreditation Program for Breast Centers. NAPBC Standards Manual. 2014 ed. Chicago: American College of Surgeons; 2014. https://www.facs.org/~/media/files/quality%20programs/napbc/2014%20napbc%20standards%20manual.ashx. Accessed 15 May 2015.

  12. Moyer VA, U.S. Preventive Services Task Force. Risk assessment, genetic counseling, and genetic testing for BRCA-related cancer in women: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;160:271–81.

    PubMed  Google Scholar 

  13. The Genetic Information Nondiscrimination Act of 2008. http://www.eeoc.gov/laws/statutes/gina.cfm. Accessed 20 May 2015.

  14. Patenaude AF, Dorval M, DiGianni LS, Schneider KA, Chittenden A, Garber JE. Sharing BRCA1/2 test results with first-degree relatives: factors predicting who women tell. J Clin Oncol. 2006;24:700–6.

    Article  PubMed  Google Scholar 

  15. Surbone A. Social and ethical implications of BRCA testing. Ann Oncol. 2011;22:160–6.

    Article  Google Scholar 

  16. Irwin B, Peppercorn J. Promise and perils of guidelines in quality cancer care. J Oncol Pract. 2012;8:354–7.

    Article  PubMed Central  PubMed  Google Scholar 

  17. American Society of Breast Surgeons Consensus Statement on Accelerated Partial Breast Irradiation. 2011. https://www.breastsurgeons.org/new_layout/about/statements/index.php. Accessed 15 May 2015.

  18. Smith B, Arthur DW, Buchholz TA. Accelerated Partial Breast Irradiation Consensus Statement from American Society for Radiation Oncology (ASTRO). Int J Rad Oncol Biol Phys. 2009;74:987–1001.

    Article  Google Scholar 

  19. Shah C, Vicini F, Wazer DE, Arthur D, Patel RR. The American Brachytherapy Society consensus statement for accelerated partial breast irradiation. Brachytherapy. 2013;12:267–77.

    Article  PubMed  Google Scholar 

  20. Thuerlimann B, Koeberle D, Senn H. Guidelines for the adjuvant treatment of postmenopausal women with endocrine-responsive breast cancer: past, present and future recommendations. Eur J Cancer. 2007;43:46–52.

    Article  PubMed  Google Scholar 

  21. Verma S, Trudeau M. Canadian oncologists attitudes towards guideline development and outcomes of clinical trials based on results of the ATAC trial [abstract]. Proceedings of the 26th Annual San Antonio Breast Cancer Symposium. December 3–6; 2003. Abstract 657.

  22. Palazzi M, De Tomasi D, D’Affronto C, et al. Are international guidelines for the prescription of adjuvant treatment for early breast cancer followed in clinical practice? Results of a population based study on 1547 patients. Tumori. 2002;88:503–6.

    PubMed  Google Scholar 

  23. Roila F, Ballatori E, Patoia L, et al. Drug utilization review team in oncology. Adjuvant systemic therapies in women with breast cancer: an audit of clinical practice in Italy. Ann Oncol. 2003;14:843–8.

    Article  CAS  PubMed  Google Scholar 

  24. Hebert-Croteau N, Brisson J, Latreille J, et al. Compliance with consensus recommendations for systemic therapy is associated with improved survival of women with node-negative breast cancer. J Clin Oncol. 2004;22:3685–93.

    Article  PubMed  Google Scholar 

  25. Bloom BS, de Pouvourville N, Chhatre S, Jayadevappa R, Weinberg D. Breast cancer treatment in clinical practices compared to best evidence and practice guidelines. Br J Cancer. 2004;90:26–30.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Landercasper J, Dietrich LL, Johnson JM. A breast center review of compliance with National Comprehensive Cancer Network Breast Cancer guidelines. Am J Surg. 2006;192:526–7.

    Article  Google Scholar 

  27. Wu X-C, Lund MJ, Kimmick GG, et al. Influence of race, insurance, socioeconomic status, and hospital type on receipt of guideline-concordant adjuvant systemic therapy for locoregional breast cancers. J Clin Oncol. 2012;30:142–8.

    Article  PubMed  Google Scholar 

  28. Lim T, Marin D. The assessment of decisional capacity. Neuro Clin. 2011;29:115–26.

    Article  Google Scholar 

  29. Sessums LL, Zembrzuska H, Jackson JL. Does this patient have medical decision-making capacity? JAMA. 2011;306:420–7.

    Article  CAS  PubMed  Google Scholar 

  30. Brendel RW, Wei MH, Schouten R, Edersheim JG. An approach to selected legal issues: confidentiality, mandatory reporting, abuse and neglect, informed consent, capacity decisions, boundary issues, and malpractice claims. Med Clinic NA. 2010;94:1229–40.

    Article  Google Scholar 

  31. Paterick T, Carson G, Allen M, et al. Medical informed consent: general considerations for physicians. Mayo Clin Proc. 2008;83:313–9.

    Article  PubMed  Google Scholar 

  32. Emanuel E. A review of the ethical and legal aspects of terminating medical care. Am J Med. 1988;84:291–301.

    Article  CAS  PubMed  Google Scholar 

  33. Braddock CH III. Do different standards apply to withholding and withdrawing care? Termination of Life-Sustaining Treatment. [University of Washington School of Medicine Department of Bioethics & Humanities Ethics in Medicine website, Bioethics Topics]. 1998 (last modified April 6, 2009). https://depts.washington.edu/bioethx/topics/termlife.html#vs. Accessed 8 May 2015.

  34. Ackerman RJ. Withholding and withdrawing life-sustaining treatment. Am Fam Phys. 2000;62:1555–60.

    Google Scholar 

  35. National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research. Bethesda, MD: US Government Printing Office; 1978. http://www.hhs.gov/ohrp/humansubjects/guidance/belmont.html. Accessed 15 May 2015.

  36. McDonald PJ, Kulkarni AV, Farrokhyar F, Bhandari M. Ethical issues in surgical research. Can J Surg. 2010;53:133–6.

    PubMed Central  PubMed  Google Scholar 

  37. Transparency reports and reporting of physician ownership or investment interests. Social Security Act. Section 1128G. http://www.ssa.gov/OP_Home/ssact/title11/1128G.htm. Accessed 20 May 2015.

  38. Angelos P. Surgical ethics and the challenge of surgical innovation. Am J Surg. 2014;208(6):881–5.

    Article  PubMed  Google Scholar 

  39. Shore R, Halsey J, Shah K, et al. Report of the AMA council on ethical and judicial affairs: report on professionalism and use of social media. J Clin Ethics. 2011;22:165–72.

    PubMed  Google Scholar 

  40. Professionalism in the use of social media. Code of Medical Ethics of the American Medical Association [e-book]. 2014–15 edn. American Medical Association, Chicago. Sec 9.124:641–848.

  41. Shay D. Physician use of social media: navigating the risk. Med Econ. 2014;25:44–6.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Alyssa Throckmorton MD, FACS.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Throckmorton, A., VanderWalde, L., Brackett, C. et al. The Ethics of Breast Surgery. Ann Surg Oncol 22, 3191–3196 (2015). https://doi.org/10.1245/s10434-015-4751-5

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-015-4751-5

Keywords

Navigation