"Choosing Wisely" Report
 

Recently a number of medical specialty associations were each asked to name five tests or practices that should be discontinued because they are ineffective and/or counterproductive.

The American Society of Clinical Oncology said, among other things, not to do routine staging with newly-diagnosed patients at "low risk" of metastasis, defined as stage 0, 1 or 2 with no symptoms.

It's hard not to personalize such things, but following that recommendation would have misdiagnosed me as Stage 2. I would have had surgery, chemo, and (maybe) radiation. From my research, there is at least some evidence that surgery (and/or general anesthesia) might exacerbate metastasis.

From what I gather about HER-2, there may be no such thing as "low risk" of metastasis with a HER-2 positive cancer.

See for yourselves: http://choosingwisely.org/wp-content...c_Clin_Onc.pdf

Re: "Choosing Wisely" Report
 

Her2 +++ is considered high risk.

Noted in the statement:

"These test and treatment options should not be administered unless the physician and patient have carefully considered if their use is appropriate in the individual case."

Re: "Choosing Wisely" Report
 

It is about time that doctors start individualizing treatments more !!!!!!!! Just because such and such happened in a clinical trial it does not mean that everyone should be treated in the same way.
It may take more effort to individualize treatments for patients, but it is neccessary to do that as much as possible. Everyone's body does not behave the same as everyone else's body does.

Re: "Choosing Wisely" Report
 

I understand the logic of avoiding expensive screening tests that are unlikely to make a difference in outcome. And I know I have no evidence that finding it at diagnosis in my case is making any difference in my ultimate outcome. I do know I avoided surgery, and I'm grateful for that. (Plus, obviously, I avoided the expense of surgery.)

But something else I read about the rationale here (and couldn't find again when I wanted to post it) gave pause. It seemed to be based on the assumption that "catching it early" makes it "potentially curable," and its corollary, that Stage IV is incurable no matter how early you diagnose it. Further, it assumed that routine mammography, which has been finding it at earlier stages, has resulted in better overall survival. That conclusion is has been contested of late.

The other four recommendations make sense to me. I'd be satisfied with the one about staging if they said HER-2 is never "low risk." It doesn't seem to "need" to have reached a certain size or a certain amount of lymph node involvement before it metastasizes. Not all oncologists are up on that. A friend of mine, also Stage IV at diagnosis, was not treated with Herceptin at first.