Published 17 March 2009, doi:10.1136/bmj.b1067
Cite this as: BMJ 2009;338:b1067

Letters

NICE update on breast cancer

Immediate breast reconstruction should be challenged

The first 150 words of the full text of this article appear below.

The tenet that immediate breast reconstruction improves health related quality of life underlines the increasing practice of breast reconstruction internationally.1 2 However, there is no good clinical evidence to support this. A systematic review of relevant journals showed a lack of level I evidence—2% randomised controlled trials, 15% cohort studies, and 80% case reports—and a threshold of methodological rigour of levels IV and V.3

Systematic review of whether breast reconstruction improves health related quality of life for women facing mastectomy did not show an improvement in all domains.4 Two single centre randomised controlled trials showed no difference between immediate and delayed breast reconstruction and between types of delayed breast reconstruction regardless of radiotherapy.4 The nine prospective longitudinal cohort studies and the 23 retrospective cross sectional studies showed inconsistent results.4

Heightened awareness is needed to produce the highest levels of scientific evidence to inform the correct choice for patients and clinicians. To . . . [Full text of this article]

Zoë Ellen Winters, consultant senior lecturer in breast surgery and head1

1 Breast Reconstruction HRQL Group, Clinical Sciences South Bristol, University Hospitals of Bristol NHS Foundation Trust, Bristol BS2 8HW

Zoe.winters@bristol.ac.uk


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Rapid Responses:

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Immediate breast reconstruction has important benefits.
Darren J McKeown, et al.
bmj.com, 22 Apr 2009 [Full text]
Clinical decision-making in immediate breast reconstruction should be based on level I to II clinical evidence and patient selection
Zoe E Winters
bmj.com, 25 Apr 2009 [Full text]
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