Select Choices in Benign Breast Disease: An Initiative of the American Society of Breast Surgeons for the American Board of Internal Medicine Choosing Wisely® Campaign

Roshni Rao, Kandace Ludwig, Lisa Bailey, Tiffany S. Berry, Robert Buras, Amy Degnim, Oluwadamilola M. Fayanju, Joshua Froman, Negar Golesorkhi, Caprice Greenburg, Ayemoe Thu Ma, Starr Koslow Mautner, Helen Krontiras, Michelle Sowden, Barbara Wexelman, Jeffrey Landercasper

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Up to 50% of all women encounter benign breast problems. In contrast to breast cancer, high-level evidence is not available to guide treatment. Management is therefore largely based on individual physician experience/training. The American board of internal medicine (ABIM) initiated its Choosing Wisely® campaign to promote conversations between patients and physicians about challenging the use of tests or procedures which may not be necessary. The American society of breast surgeons (ASBrS) Patient safety and quality committee (PSQC) chose to participate in this campaign in regard to the management of benign breast disease. Methods: The PSQC solicited initial candidate measures. PSQC surgeons represent a wide variety of practices. The resulting measures were ranked by modified Delphi appropriateness methodology in two rounds. The final list was approved by ASBrS and endorsed by the ABIM. Results: The final five measures are as follows. (1) Don’t routinely excise areas of pseuodoangiomatous stromal hyperplasia (PASH) of the breast in patients who are not having symptoms from it. (2) Don’t routinely surgically excise biopsy-proven fibroadenomas that are < 2 cm. (3) Don’t routinely operate for a breast abscess without an initial attempt to percutaneously aspirate. (4) Don’t perform screening mammography in asymptomatic patients with normal exams who have less than a 5-years life expectancy. (5) Don’t routinely drain nonpainful, fluid-filled cysts. Conclusions: The ASBrS Choosing Wisely® measures that address benign breast disease management are easily accessible to patients via the internet. Consensus was reached by PSQC regarding these recommendations. These measures provide guidance for shared decision-making.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalAnnals of Surgical Oncology
DOIs
StateAccepted/In press - Jul 2 2018

Fingerprint

Breast Diseases
Internal Medicine
Breast
Patient Safety
Cyst Fluid
Physicians
Fibroadenoma
Mammography
Disease Management
Life Expectancy
Internet
Abscess
Hyperplasia
Consensus
Decision Making
Breast Neoplasms
Biopsy
Surgeons

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Select Choices in Benign Breast Disease : An Initiative of the American Society of Breast Surgeons for the American Board of Internal Medicine Choosing Wisely® Campaign. / Rao, Roshni; Ludwig, Kandace; Bailey, Lisa; Berry, Tiffany S.; Buras, Robert; Degnim, Amy; Fayanju, Oluwadamilola M.; Froman, Joshua; Golesorkhi, Negar; Greenburg, Caprice; Ma, Ayemoe Thu; Mautner, Starr Koslow; Krontiras, Helen; Sowden, Michelle; Wexelman, Barbara; Landercasper, Jeffrey.

In: Annals of Surgical Oncology, 02.07.2018, p. 1-6.

Research output: Contribution to journalArticle

Rao, R, Ludwig, K, Bailey, L, Berry, TS, Buras, R, Degnim, A, Fayanju, OM, Froman, J, Golesorkhi, N, Greenburg, C, Ma, AT, Mautner, SK, Krontiras, H, Sowden, M, Wexelman, B & Landercasper, J 2018, 'Select Choices in Benign Breast Disease: An Initiative of the American Society of Breast Surgeons for the American Board of Internal Medicine Choosing Wisely® Campaign', Annals of Surgical Oncology, pp. 1-6. https://doi.org/10.1245/s10434-018-6584-5
Rao, Roshni ; Ludwig, Kandace ; Bailey, Lisa ; Berry, Tiffany S. ; Buras, Robert ; Degnim, Amy ; Fayanju, Oluwadamilola M. ; Froman, Joshua ; Golesorkhi, Negar ; Greenburg, Caprice ; Ma, Ayemoe Thu ; Mautner, Starr Koslow ; Krontiras, Helen ; Sowden, Michelle ; Wexelman, Barbara ; Landercasper, Jeffrey. / Select Choices in Benign Breast Disease : An Initiative of the American Society of Breast Surgeons for the American Board of Internal Medicine Choosing Wisely® Campaign. In: Annals of Surgical Oncology. 2018 ; pp. 1-6.
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abstract = "Background: Up to 50{\%} of all women encounter benign breast problems. In contrast to breast cancer, high-level evidence is not available to guide treatment. Management is therefore largely based on individual physician experience/training. The American board of internal medicine (ABIM) initiated its Choosing Wisely{\circledR} campaign to promote conversations between patients and physicians about challenging the use of tests or procedures which may not be necessary. The American society of breast surgeons (ASBrS) Patient safety and quality committee (PSQC) chose to participate in this campaign in regard to the management of benign breast disease. Methods: The PSQC solicited initial candidate measures. PSQC surgeons represent a wide variety of practices. The resulting measures were ranked by modified Delphi appropriateness methodology in two rounds. The final list was approved by ASBrS and endorsed by the ABIM. Results: The final five measures are as follows. (1) Don’t routinely excise areas of pseuodoangiomatous stromal hyperplasia (PASH) of the breast in patients who are not having symptoms from it. (2) Don’t routinely surgically excise biopsy-proven fibroadenomas that are < 2 cm. (3) Don’t routinely operate for a breast abscess without an initial attempt to percutaneously aspirate. (4) Don’t perform screening mammography in asymptomatic patients with normal exams who have less than a 5-years life expectancy. (5) Don’t routinely drain nonpainful, fluid-filled cysts. Conclusions: The ASBrS Choosing Wisely{\circledR} measures that address benign breast disease management are easily accessible to patients via the internet. Consensus was reached by PSQC regarding these recommendations. These measures provide guidance for shared decision-making.",
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AU - Ludwig, Kandace

AU - Bailey, Lisa

AU - Berry, Tiffany S.

AU - Buras, Robert

AU - Degnim, Amy

AU - Fayanju, Oluwadamilola M.

AU - Froman, Joshua

AU - Golesorkhi, Negar

AU - Greenburg, Caprice

AU - Ma, Ayemoe Thu

AU - Mautner, Starr Koslow

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AU - Sowden, Michelle

AU - Wexelman, Barbara

AU - Landercasper, Jeffrey

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N2 - Background: Up to 50% of all women encounter benign breast problems. In contrast to breast cancer, high-level evidence is not available to guide treatment. Management is therefore largely based on individual physician experience/training. The American board of internal medicine (ABIM) initiated its Choosing Wisely® campaign to promote conversations between patients and physicians about challenging the use of tests or procedures which may not be necessary. The American society of breast surgeons (ASBrS) Patient safety and quality committee (PSQC) chose to participate in this campaign in regard to the management of benign breast disease. Methods: The PSQC solicited initial candidate measures. PSQC surgeons represent a wide variety of practices. The resulting measures were ranked by modified Delphi appropriateness methodology in two rounds. The final list was approved by ASBrS and endorsed by the ABIM. Results: The final five measures are as follows. (1) Don’t routinely excise areas of pseuodoangiomatous stromal hyperplasia (PASH) of the breast in patients who are not having symptoms from it. (2) Don’t routinely surgically excise biopsy-proven fibroadenomas that are < 2 cm. (3) Don’t routinely operate for a breast abscess without an initial attempt to percutaneously aspirate. (4) Don’t perform screening mammography in asymptomatic patients with normal exams who have less than a 5-years life expectancy. (5) Don’t routinely drain nonpainful, fluid-filled cysts. Conclusions: The ASBrS Choosing Wisely® measures that address benign breast disease management are easily accessible to patients via the internet. Consensus was reached by PSQC regarding these recommendations. These measures provide guidance for shared decision-making.

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