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.
Similar content being viewed by others
References
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.
Rosenthal, Angelos P, Cooper DS, et al. Clinical and professional ethics guidelines for the practice of thyroidology. Thyroid. 2013;23:1203–10.
Rosenthal MS. Ethical issues in the management of thyroid disease. Endocrinol Metab Clin North Am. 2014;43:545–64.
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.
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.
Adedeji S, Sokol DK, Palser T, McKneally M. Ethics of surgical complications. World J Surg. 2009;33:732–7.
Loewenstein G. Projection bias in medical decision making. Med Decision Making. 2005;25:96–105.
Langstein HN, Cheng MH, Singletary SE, et al. Breast cancer recurrence after immediate reconstruction: patterns and significance. Plast Reconstr Surg. 2003;111;712–20.
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.
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.
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.
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.
The Genetic Information Nondiscrimination Act of 2008. http://www.eeoc.gov/laws/statutes/gina.cfm. Accessed 20 May 2015.
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.
Surbone A. Social and ethical implications of BRCA testing. Ann Oncol. 2011;22:160–6.
Irwin B, Peppercorn J. Promise and perils of guidelines in quality cancer care. J Oncol Pract. 2012;8:354–7.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Lim T, Marin D. The assessment of decisional capacity. Neuro Clin. 2011;29:115–26.
Sessums LL, Zembrzuska H, Jackson JL. Does this patient have medical decision-making capacity? JAMA. 2011;306:420–7.
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.
Paterick T, Carson G, Allen M, et al. Medical informed consent: general considerations for physicians. Mayo Clin Proc. 2008;83:313–9.
Emanuel E. A review of the ethical and legal aspects of terminating medical care. Am J Med. 1988;84:291–301.
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.
Ackerman RJ. Withholding and withdrawing life-sustaining treatment. Am Fam Phys. 2000;62:1555–60.
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.
McDonald PJ, Kulkarni AV, Farrokhyar F, Bhandari M. Ethical issues in surgical research. Can J Surg. 2010;53:133–6.
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.
Angelos P. Surgical ethics and the challenge of surgical innovation. Am J Surg. 2014;208(6):881–5.
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.
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.
Shay D. Physician use of social media: navigating the risk. Med Econ. 2014;25:44–6.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
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
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-015-4751-5