Low-cost solutions incorporated in a standard surgical pathway for early breast cancer: A pilot study

Abstract

We present the results of incorporation of low-cost solutions to provide a standard surgical care for early breast cancer (EBC) patients. This surgical pathway consists of a low-cost vacuum-assisted core needle biopsy, sentinel lymph node biopsy (SLNB) using low-cost methylene blue and fluorescin dyes under local anesthesia and oncoplastic breast surgery. Patients assessed as clinically node-negative axilla underwent such treatment. SLNB using low-cost dyes was performed without any complication. Oncoplastic surgical techniques were opted for in 32 patients, and the lumps were all excised with a ∼1-cm all-around margin on the final histopathological examination. Standard breast cancer surgery can be provided in low-resource settings to eligible EBC patients with low-cost solutions.

Ten lessons for global surgery researchers

“…Quality of surgical care in LMICs can be improved with the help of locally developed low-cost affordable surgical solutions/innovations, in response to their unique challenges 3,25 . These evidence-based solutions can easily replace those with disproportionately high cost and can be incorporated into standard surgical pathways 26,27 . To paraphrase U.S. President Abraham Lincoln's Gettysburg Address these global surgery solutions are 'of the people, by the people, for the people'.…”

Low Value Surgical Care: Are We Choosing Wisely?

“…There is little research on de-implementation in LMICs but clearly a tremendous opportunity exists to weed out LVSC, avoid wasteful practices, and use the resultant significant savings to close the equity gaps in the delivery of high-quality surgical care [7,8]. Evidence-based affordable solutions can easily replace those with disproportionately high cost and play an important role in this endeavor [9][10][11][12]. However, it must be ensured that idealistically pursued de-implementation efforts do not exacerbate existing inequities [13].…”