Published 10 March 2009, doi:10.1136/bmj.b776
Cite this as: BMJ 2009;338:b776

Analysis

Commentary: The lay view

¹ London

If my life had been made unbearable by outsize breasts, and I was finally to undergo the operation leading to their reduction, I think I would be feeling a mixture of anxiety and euphoria as I waited for the anaesthetic. At last, I’d be thinking, life was about to improve immeasurably. No more back ache, chafing, embarrassment, unflattering clothes. Furthest from my mind would be the thought that the surgeons might find cancerous tissue in my breast.

Imagine coming round from the operation: yes, the weight has literally been lifted from your chest. The operation has worked. But there is something else: the surgeon wishes to have a little chat with you. In private. Still tender from surgery, you’re told that cancerous cells were found in your breast tissue after routine screening. Would you like to opt for radiotherapy, or perhaps a complete mastectomy?

I exaggerate the brutality of this little interview—but for the woman in this case report, this is essentially what she will have understood. She went in to acquire more flattering curves. She came out with cancer. Nothing prepared her for this discovery.

Why, she asks, didn’t you warn her that there was a risk, no matter how slight, of finding cancer? Why was there no counselling, if you knew you were going to send part of her breast away for histological screening? It would have helped her with the shock, and perhaps encouraged her to think of the operation less as a little cosmetic nip and tuck (as cosmetic surgery is so often presented to women) and more of a surgical procedure.

The other disturbing aspect to this report is the apparently random nature of the sampling and screening. It seems nearly impossible to identify exactly where in the breast the tissue came from (the specimens were not oriented). If you’re going to bother with histological screening, surely it should be done as conscientiously as possible, given the chance (however slight) of discovering cancer?

Like any potential patient, I welcome any procedures made to safeguard my health and would appreciate being informed of every aspect (and associated risk) of an operation. I would not appreciate being left in the dark.

This is supposedly an era of accountability and transparency—of the patient being put first. The current practice of screening of breast tissue after reduction mammoplasty should be maintained and perhaps refined, but the patient should, from start to finish, be kept in the loop. Who else, after all, is this screening supposed to benefit?

Cite this as: BMJ 2009;338:b776

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Competing interests: None declared.

Provenance and peer review: Commissioned; not externally peer reviewed.

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