Medicolegal implications of advice for surgical treatment of breast cancer

I read with interest a letter by Ngaserin et al. published in the Annals.1 The acknowledgement that breast conservation treatment (BCT) for eligible women with breast cancer results in higher survival than mastectomy is heartening. There has been data since 2007 reporting that women who underwent BCT had better survival outcomes.2 This early data was subsequently supported by such a significant body of evidence in the ensuing years that in 2016, Johns et al. recommended that all eligible patients should undergo BCT. 3 It was also suggested that it may no longer be appropriate for such patients to be offered the choice of mastectomy, as the latter did not provide an equivalent survival outcome.3 In 2021, this treatment approach was reinforced by further cumulative data of close to 1 million patients providing robust evidence that there is a consistent benefit of overall survival in favour of breast-conserving surgery.4 There are more recent studies that demonstrate a survival benefit of 56–70% with BCT compared with mastectomy.5 Based on their findings, de Boniface et al. echo the sentiment of Johns & Dixon,3 and state that for breast cancer patients who are eligible for BCT, mastectomy cannot be considered to offer equivalent outcomes.5 A Singapore study by Leong et al. published in 2022 compared the survival outcomes of breast conserving surgery (BCS) with radiotherapy (BCT) and mastectomy. 6 While the degree of survival advantage may not be directly comparable to that observed by de Boniface et al, an improved survival outcome with BCT was also reported in Singapore.5,6