Should SLNB be the standard of care?
Dr. Kissin went on to say, "There shouldn't really be a choice anymore. Sentinel node biopsy, for the patient, should be the standard of care."
I do not necessarily differ with the suggestion that sentinel biopsy for breast cancer may well be important. But one must remember that this standard of care has occurred because of the free choices and ability of well-trained, broad-thinking surgeons to evaluate research data over the history of breast cancer treatment to come up with a protocol that would first allow for SLNB research to have been done. To arbitrarily have a British health commission dictate that this is the standard of care not only blunts and eliminates the investigatory and thinking patterns of surgeons, but also may restrict further research and evaluation into breast cancer.
Surgeons should be allowed to freely discuss with patients the options of all types of therapies, and should help those patients determine what is appropriate. As physicians, we should be very leery of any edict or dictum coming from a bureaucratic governmental organization in determining the "standard of care."
Gerhard H. Mundinger Jr., M.D.