Featured Research

from universities, journals, and other organizations

Concerns raised over the effectiveness of a costly and invasive procedure for melanoma

Date:
January 8, 2013
Source:
BMJ-British Medical Journal
Summary:
A special report finds that thousands of melanoma patients around the world are undergoing an expensive and invasive procedure called sentinel node biopsy, despite a lack of clear evidence and concerns that it may do more harm than good.

A special report published by the British Medical Journal on January 8 finds that thousands of melanoma patients around the world are undergoing an expensive and invasive procedure called sentinel node biopsy, despite a lack of clear evidence and concerns that it may do more harm than good.

Although not recommended for routine use in England, it has become the standard care for melanoma patients in several countries including the United States, where it was estimated to cost over $686m in 2012.

Melanoma is the fifth most common cancer in the UK, affecting one in 60 people. In the US it affects one in 50 people and, of the seven most common cancers, is the only one that is increasing. Sentinel node biopsy was developed in the US in the early 1990s to detect the early spread of cancer cells in patients with melanoma. It involves taking a small sample of the lymph node (gland) nearest to the melanoma for testing. If cancer cells are found, patients are advised to have surgery to remove some of the surrounding lymph nodes.

In 2006, a major trial (known as MSLT-I) published in the New England Journal of Medicine found that sentinel node biopsy did not improve overall survival after five years, yet the researchers claimed that disease-free survival was significantly higher in the biopsy group.

The results proved controversial, but further analyses of the data (expected around 2008 and 2011) that would have settled the question of effectiveness once and for all have not yet been published.

In 2007, the US National Cancer Institute, which funded the trial, accepted that it remained open to debate whether sentinel node biopsy should be standard care, but there has been no correction or clarification issued by the researchers or the journal. Nor has there been any public explanation about the delay in publishing the further analyses.

And when the BMJ contacted the lead researcher, he gave no timescale for when publication of the results could be expected.

Meanwhile, large numbers of patients are being exposed to unnecessary and potentially harmful surgery. It is thought that as many as 96% of patients who have sentinel node biopsy will have unnecessary surgery, which carries a risk of complications such as lymphoedema (severe swelling of the limbs), cellulitis (deep skin infection) and scarring.

In England, guidance from the National Institute for Health and Clinical Excellence (NICE) states that sentinel node biopsy should be performed only in centres with expertise in the context of clinical trials. Yet data obtained by the BMJ show that at least 19 trusts across England carried out sentinel node biopsy procedures on melanoma patients between 2006 and 2011.

The figures also suggest that in 2010-11, over 1,100 sentinel node biopsies could have been conducted at an estimated cost to the NHS of 7.6m. Given only two trials of sentinel node biopsy in melanoma are ongoing, this is likely to account for only a fraction of these biopsies.

The report concludes: "The full and final results of MSLT-I would clarify whether sentinel node biopsy is beneficial, and what, if any, its role in melanoma should be. It is time for the funders of MSLT-1 and those responsible for overseeing research to demand prompt publication of the full and final results of MSLT-I."

Commenting on the report, BMJ Editor Dr Fiona Godlee, says the evidence that much research goes unreported is overwhelming, putting patients at risk and wasting healthcare resources. She calls on both industry and academia to clean up their act.


Story Source:

The above story is based on materials provided by BMJ-British Medical Journal. Note: Materials may be edited for content and length.


Journal Reference:

  1. I. Torjesen. Sentinel node biopsy for melanoma: unnecessary treatment? BMJ, 2013; 346 (jan08 12): e8645 DOI: 10.1136/bmj.e8645

Cite This Page:

BMJ-British Medical Journal. "Concerns raised over the effectiveness of a costly and invasive procedure for melanoma." ScienceDaily. ScienceDaily, 8 January 2013. <www.sciencedaily.com/releases/2013/01/130108201647.htm>.
BMJ-British Medical Journal. (2013, January 8). Concerns raised over the effectiveness of a costly and invasive procedure for melanoma. ScienceDaily. Retrieved September 16, 2014 from www.sciencedaily.com/releases/2013/01/130108201647.htm
BMJ-British Medical Journal. "Concerns raised over the effectiveness of a costly and invasive procedure for melanoma." ScienceDaily. www.sciencedaily.com/releases/2013/01/130108201647.htm (accessed September 16, 2014).

Share This



More Health & Medicine News

Tuesday, September 16, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

President To Send 3,000 Military Personnel To Fight Ebola

President To Send 3,000 Military Personnel To Fight Ebola

Newsy (Sep. 16, 2014) President Obama is expected to send 3,000 troops to West Africa as part of the effort to contain Ebola's spread. Video provided by Newsy
Powered by NewsLook.com
Man Floats for 31 Hours in Gulf Waters

Man Floats for 31 Hours in Gulf Waters

AP (Sep. 16, 2014) A Texas man is lucky to be alive after he and three others floated for more than a day in the Gulf of Mexico when their boat sank during a fishing trip. (Sept. 16) Video provided by AP
Powered by NewsLook.com
Ivorians Abandon Monkey Pets in Fear Over Ebola Virus

Ivorians Abandon Monkey Pets in Fear Over Ebola Virus

AFP (Sep. 16, 2014) Since the arrival of Ebola in Ivory Coast, Ivorians have been abandoning their pets, particularly monkeys, in the fear that they may transmit the virus. Duration: 00:47 Video provided by AFP
Powered by NewsLook.com
Study Links Male-Pattern Baldness To Prostate Cancer

Study Links Male-Pattern Baldness To Prostate Cancer

Newsy (Sep. 16, 2014) New findings suggest men with a certain type of baldness at age 45 are 39 percent more likely to develop aggressive prostate cancer. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins