Journal of the American College of Surgeons
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We sought to evaluate recent trends in the United States of America regarding malpractice awards for patients with carcinoma of the breast. ⋯ Most malpractice complaints related to carcinoma of the breast are instituted by women under the age of 50 years who identified the breast mass by themselves and were assumed by their physicians to have fibrocystic disease of the breast. Complaints can be expected to increase regarding failure to order further diagnostic tests, such as ultrasound or fine-needle aspiration biopsy, despite a negative mammogram. Complaints against HMOs are now also being made, citing failure to properly diagnose or treat patients with carcinoma of the breast.
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Although over 7,000 people die from malignant melanoma each year, there are limited prognostic data for patients with metastatic disease. A retrospective analysis was undertaken to identify variables that accurately predict outcome and to determine if the survival rate of patients with melanoma treated for distant metastases (American Joint Committee on Cancer [AJCC] stage IV disease) at the authors' institution changed between 1971 and 1993. ⋯ Despite new treatment options, the survival rate of patients with metastatic melanoma has not changed significantly over the last 22 years; their prognosis remains dismal. The three prognostic variables identified in this study should be considered in the design of future clinical trials.
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The Commission on Cancer (COC) of The American College of Surgeons periodically reviews criteria for evaluation of the care of patients with cancer related to diagnosis, treatment, rehabilitation, and follow-up. The COC annually performs a national survey of practices for several cancer sites. ⋯ The distribution of cases by anatomic site was consistent with a hypothesis of rightward migration of colon carcinoma. Colon and rectal carcinomas in African-Americans were reported in more advanced stages and with corresponding decreases in survival rates. Some patterns of nonoptimal diagnostic use were noted. The increasing use of sphincter-sparing surgical alternatives for carcinoma of the rectum was evident. Adjuvant therapy was not widely used during this period. This study suggests evolving patterns of evaluation, increased preservation of continence, and improved but varying survival among ethnic groups. It further suggests that survival as measured across these 943 hospitals may be lower than that attained at some individual centers.