COST-EFFECTIVE PREOPERATIVE EVALUATION, OPERATIVE TREATMENT, AND POSTOPERATIVE FOLLOW-UP IN THE BREAST-CANCER PATIENT

This article hopes to bring attention to the contemporary attitudes ab out resource-effective, cost-effective, and practical preoperative eva luation and operative and follow-up procedures in breast cancer patien ts. Frequently, oncology specialists, particularly medical oncologists , are trained in research institutions that demand extensive testing f or the sake of research protocols. Those extraordinarily detailed and careful studies do not need to be carried over into routine clinical p ractice. As a matter of fact, it has been shown again and again in the literature that markedly simplified formulas for preoperative work-up and follow-up of breast cancer patients are equally effective in term s of outcome at enormous savings in cost and time. Until the time when metastatic breast cancer can be cured, careful detailed follow-up wil l be unimportant as cure is impossible and palliation is the goal. It is impossible to palliate an asymptomatic patient; therefore, searchin g for asymptomatic, incurable disease is a disservice to patients. Fur thermore, with the move towards breast conservation, extraordinary att empts to document distant metastases preoperatively are not justified as the patients are left anatomically intact in the majority of early breast cancer presentations.