title: Measures of Appropriateness and Value for Breast Surgeons and Their Patients: The American Society of Breast Surgeons Choosing Wisely (®) Initiative.
abstract: Current breast cancer care is based on high-level evidence from randomized, controlled trials. Despite these data, there continues to be variability of breast cancer care, including overutilization of some tests and operations. To reduce overutilization, the American Board of Internal Medicine Choosing Wisely (®) Campaign recommends that professional organizations provide patients and providers with a list of care practices that may not be necessary. Shared decision making regarding these services is encouraged.
  
  
  
  The Patient Safety and Quality Committee of the American Society of Breast Surgeons (ASBrS) solicited candidate measures for the Choosing Wisely (®) Campaign. The resulting list of "appropriateness" measures of care was ranked by a modified Delphi appropriateness methodology. The highest-ranked measures were submitted to and later approved by the ASBrS Board of Directors. They are listed below.
  
  
  
  (1) Don't routinely order breast magnetic resonance imaging in new breast cancer patients. (2) Don't routinely excise all the lymph nodes beneath the arm in patients having lumpectomy for breast cancer. (3) Don't routinely order specialized tumor gene testing in all new breast cancer patients. (4) Don't routinely reoperate on patients with invasive cancer if the cancer is close to the edge of the excised lumpectomy tissue. (5) Don't routinely perform a double mastectomy in patients who have a single breast with cancer.
  
  
  
  The ASBrS list for the Choosing Wisely (®) campaign is easily accessible to breast cancer patients online. These measures provide surgeons and their patients with a starting point for shared decision making regarding potentially unnecessary testing and operations.
authors.affiliation: Gundersen Medical Foundation, La Crosse, WI, USA. jlanderc@gundersenhealth.org.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Landercasper
authors.affiliation: Bay Area Breast Surgeons, Inc., Oakland, CA, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Bailey
authors.affiliation: Norton Healthcare, Louisville, KY, USA.
authors.forename: Tiffany S
authors.initials: TS
authors.lastname: Berry
authors.affiliation: Anne Arundel Medical Center, Annapolis, MD, USA.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Buras
authors.affiliation: Mayo Clinic, Rochester, MN, USA.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Degnim
authors.affiliation: MD Anderson, Houston, TX, USA.
authors.forename: Oluwadamilola M
authors.initials: OM
authors.lastname: Fayanju
authors.affiliation: Mayo Clinic Health System, Owatonna, MN, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Froman
authors.affiliation: Women and Infants Hospital, Providence, RI, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gass
authors.affiliation: University of Wisconsin School of Public Health and Medicine, Madison, WI, USA.
authors.forename: Caprice
authors.initials: C
authors.lastname: Greenberg
authors.affiliation: Baptist Health South Florida, Miami, FL, USA.
authors.forename: Starr Koslow
authors.initials: SK
authors.lastname: Mautner
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Helen
authors.initials: H
authors.lastname: Krontiras
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Roshni
authors.initials: R
authors.lastname: Rao
authors.affiliation: University of Vermont Medical Center, Burlington, VT, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Sowden
authors.affiliation: Aurora Health Care, Milwaukee, WI, USA.
authors.forename: Judy A
authors.initials: JA
authors.lastname: Tjoe
authors.affiliation: Trihealth Cancer Institute, Cincinnati, OH, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Wexelman
authors.affiliation: University of Wisconsin of Madison, Madison, WI, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: Wilke
authors.affiliation: OasisMD, San Diego, CA, USA.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Chen
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D003657:Decision Making; D003697:Delphi Technique; D005260:Female; D005820:Genetic Testing / Q000706:statistics & numerical data; D006300:Health Services Misuse / Q000517:prevention & control*; D006801:Humans; D008197:Lymph Node Excision / Q000706:statistics & numerical data*; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D000072662:Margins of Excision; D015412:Mastectomy, Segmental; D018365:Neoplasm, Residual; D010358:Patient Participation; D000072036:Prophylactic Mastectomy / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care; D012086:Reoperation / Q000706:statistics & numerical data; D012955:Societies, Medical / Q000592:standards; D000071077:Surgical Oncology / Q000592:standards*