title: Contrary To Conventional Wisdom, Physicians Abandoned A Breast Cancer Treatment After A Trial Concluded It Was Ineffective.
abstract: Conventional wisdom holds that physicians are slow to abandon ineffective medical practices. We evaluated this theory in the case of axillary lymph node dissection, a procedure to remove the lymph nodes near the breast to prevent the spread of breast cancer following breast-conserving surgery. A major trial conducted from 1999 to 2004, with results presented in 2010 and published in 2011, found that patients who met certain criteria could forgo axillary lymph node dissection. Using cancer registry data, we estimated that the proportion of patients undergoing axillary dissection declined by 32.6 percentage points after the trial was published. The decline began immediately after the trial was presented at a medical conference. The rapid decline in the use of axillary dissection belies the common belief that practice patterns are slow to change in response to new evidence, and it highlights the value of trials of established medical practices to patients and the health system.
authors.affiliation: David H. Howard (david.howard@emory.edu) is an associate professor in the Department of Health Policy and Management and Winship Cancer Institute at Emory University, in Atlanta, Georgia.
authors.forename: David H
authors.initials: DH
authors.lastname: Howard
authors.affiliation: Pamela R. Soulos is a program manager and data analyst at the Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center at the Yale University School of Medicine and the Yale Cancer Center, in New Haven, Connecticut.
authors.forename: Pamela R
authors.initials: PR
authors.lastname: Soulos
authors.affiliation: Anees B. Chagpar is an associate professor of surgery in the Department of Surgery at the Yale University School of Medicine.
authors.forename: Anees B
authors.initials: AB
authors.lastname: Chagpar
authors.affiliation: Sarah Mougalian is an associate professor of surgery at the COPPER Center at the Yale University School of Medicine and the Yale Cancer Center.
authors.forename: Sarah
authors.initials: S
authors.lastname: Mougalian
authors.affiliation: Brigid Killelea is an associate professor of surgery at the COPPER Center at the Yale University School of Medicine and the Yale Cancer Center.
authors.forename: Brigid
authors.initials: B
authors.lastname: Killelea
authors.affiliation: Cary P. Gross is a professor of medicine in the Section of General Internal Medicine at the Yale University School of Medicine.
authors.forename: Cary P
authors.initials: CP
authors.lastname: Gross
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001365:Axilla / Q000601:surgery; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008197:Lymph Node Excision / Q000639:trends*; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000941:ethics / Q000639:trends*; D016032:Randomized Controlled Trials as Topic; D016079:Refusal to Treat / Q000941:ethics* / Q000706:statistics & numerical data; D018426:SEER Program; D016019:Survival Analysis; D017211:Treatment Failure; D014481:United States
keywords: Access To Care; Evidence-Based Medicine; Health Reform; Health Spending; Medical technology