Breast tissue test consent fear

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Young women undergoing breast reduction surgery are being screened for cancer without their informed consent, believes a leading UK plastic surgeon.

Mr Mohammed Keshtgar says women who want these operations should be made explicitly aware that their removed breast tissue will be checked.

He questions the ethics of doing tests with no counselling or consensus on the merits of treatment if cancer is found.

Experts debate the issues raised by the Royal Free consultant at BMJ online.

Mr Keshtgar raised his concerns following the case of a patient of his facing confusion and anxiety when diagnosed with cancer after such surgery in 2007. I do not think it is wrong to check for cancer, but these women need to be psychologically prepared Mr Keshtgar

Since then he says he makes sure all women undergoing breast reduction are fully aware that their tissue will be tested to see if there is any sign of early cancer.

Breast reduction

Breast reduction surgery is one of the most common procedures performed by plastic surgeons all around the world.

And for decades it has been common practice to test the removed tissue for cancer, even though the chances of finding cancer is extremely rare.

Although all women have to sign a consent form for the surgery and all it entails, Mr Keshtgar believes not all women are made aware of all the possible consequences, including discovering a cancer.

Mr Keshtgar said: "There has to be some sort of counselling and informed consent about the possibility of finding an early cancer. Implied consent is not enough. I do not think it is wrong to check for cancer, but these women need to be psychologically prepared.

"Even though the chance of finding something is small - something like 0.06% to 0.8% - women need to be aware, otherwise it will be a great shock."

Undue anxiety

He described finding cancer after a routine cosmetic breast operation on a 37-year-old woman.

The discovery led to a succession of further operations for the woman, ending in a mastectomy and reconstructive surgery even though it was not possible to say whether the surgery had benefited her.

Mr Keshtgar said: "At the end of the day the patient was happy but we are questioning whether we have done something good for her. Have we helped her or added to her anxiety?" It is essential that the tissue screening process, and the conditions it may detect, are fully explained to patients Jane Hatfield of Breast Cancer Care

As well as their being no evidence to support treating these cancers, often it is not possible to identify exactly where in the breast the tissue came from because tissue specimens are not orientated during surgery, he said.

"We are recommending that there has to be orientation of the specimen so we know which area of the breast to go back to."

Tom Treasure, a Professor of cardiothoracic surgery at University College London, said the question of what is the best management of a patient with these findings in the future remains unanswered.

"Not putting the tissue under the microscope may seem unacceptable.

"But so is continuing surgical practices that may result in harm, without having evidence of benefit."

Ethicist Jeremy Sugarman said getting informed consent for screening from the patient and orientating the specimens should help mitigate some of the dilemmas.

Jane Hatfield of Breast Cancer Care said: "It is essential that the tissue screening process, and the conditions it may detect, are fully explained to patients and they have the opportunity to consent to the procedure."

Sarah Woolnough, head of policy at Cancer Research UK, said: "This highlights how crucial it is that patients undergoing any medical procedure are properly informed of what they are consenting to.

"It can be extremely distressing for a woman to receive a diagnosis of breast cancer, especially if the news isn't delivered in an appropriate context."