Intended for healthcare professionals

News Roundup [abridged Versions Appear In The Paper Journal]

Subspecialty of oncoplastic breast surgery is needed to meet demand

BMJ 2003; 326 doi: (Published 29 May 2003) Cite this as: BMJ 2003;326:1165
  1. Roger Dobson
  1. Abergavenny

    A new subspecialty of oncoplastic breast surgery is needed, a new report urges. The proposals would mean specialist training being shorter and starting earlier and that specialists would be available more quickly for a growing number of patients, says the report, in the Breast (2003;12:161-2).

    An accompanying editorial by Professor Michael Baum welcomes the proposals as long overdue: “Over the last 15 years my subject has changed dramatically and along with this the technical challenge of onco-plastic surgery has emerged. Nowhere along the line did I have the opportunity for time out to train in plastic and reconstructive surgery, the one skill I would have needed to be considered a complete ‘breast man.’ I personally believe that the time is long overdue to take a serious look at the training needs of those who wish to specialise in the care of women with breast cancer.”

    He adds, “After a probationary period as a Senior House Officer/Junior Resident studying pre- and post-operative care on how to suture wounds so they won't fall apart, I see no reason why this pluri-potential general surgeon shouldn't start to differentiate into a breast specialist.”

    The report, from Mr Muhammed Humzah and Dr Joanna Skillman of Queen Victoria Hospital, East Grinstead, Sussex, says that although mortality from breast cancer is decreasing, screening has increased detection, leading to a higher demand for intervention and to greater expectations.

    The authors point out that the training of breast cancer surgery in the United Kingdom has been undertaken by general surgeons: “This has produced surgeons with surgical skills gleaned from higher surgical training posts in colorectal, upper gastrointestinal and vascular surgery that are unnecessary in a specialist breast unit. Although some general surgeons perform reconstructions with implants or pedicled flaps, they do not have the specialised skills to provide the broadest spectrum of reconstructive options.”

    The report says that specifically targeted training would allow trainees who are interested in breast reconstruction to focus on it earlier in their career: “Their training would be shorter and therefore less expensive, but also limited so that they would have a more restricted practice compared to generally trained plastic surgeons. In the climate of the new consultant contract and a lack of specialist breast surgeons, a shorter training would also provide more surgeons rapidly.”

    “The most efficient method to produce breast reconstructive surgeons would be to set up a new subspecialty in which training is focused towards this aim. This would be an attractive option for many trainees who want the variety and challenge of reconstruction in addition to the rewards of treating cancer,” the report adds.

    Professor Baum's editorial suggests that general surgeons may not rush out to embrace the concept: “I have little doubt that many of my general surgical colleagues who have passed through the system will be outraged by this suggestion as far too revolutionary and far too difficult to organise, when some poor sap is always required to be on call for general surgical emergencies.

    “How outrageous it must be to take out the young men and women from their on call commitment to emergencies simply because they wish to train in a sub-speciality where the skills of suturing a perforated ulcer are hardly ever required!”

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