CHOOSING WISELY CANADA
6 things
general surgeons and patients should question
By the Canadian Association on General Surgeons *
1
Don’t perform axillary lymph node dissection for clinical stages I and II breast cancer
with clinically negative lymph nodes without
attempting sentinel node biopsy.
Sentinel node biopsy is proven effective at staging the axilla for positive lymph nodes and is proven to have fewer
short and long term side effects, and in particular is associated with a markedly lower risk of lymphedema (permanent
arm swelling). When the sentinel lymph node(s) are negative for cancer, no axillary dissection should be performed.
When one or two sentinel nodes are involved with cancer
that is not extensive in the node, the patient received breast
conserving surgery and is planning to receive whole breast
radiation and stage appropriate systemic therapy, axillary
node dissection should not be performed.
2
Avoid the routine use of “whole-body”
diagnostic computed tomography (CT)
scanning in patients with minor or single system trauma.
Aggressive use of “whole-body” CT scanning improves early
diagnosis of injury and may even postively impact survival
in polytrauma patients. However, the significance of radiation exposure with these studies must be considered, especially in patients with low energy mechanisms of injury and
absent physical examination findings consistent with major
trauma.
3
Avoid colorectal cancer screening tests on
asymptomatic patients with a life expectancy of less than 10 years and no family or
personal history of colorectal neoplasia.
Screening for colorectal cancer has been shown to reduce
the mortality associated with this