Editor's Note Bringing out the vote

Our group has been doing electronic keypad polling at oncology meetings since 1995, and what we have observed over the years has been so interesting that we started to incorporate the results into our print education programs. Last year we produced a supplement to our Breast Cancer Update audio program based on the polling data from the Miami Breast Cancer Conference with supporting excerpts from our audio series, and the feedback was so positive that we have done it again. My review of the enclosed findings revealed that several interesting trends continue from prior years:

1. Many physicians have uncertain feelings of equipoise concerning a number of randomized clinical trials.

The Miami meeting has proven to be a fascinating laboratory in this regard. For example, we noted several years ago that randomly assigning women with node-positive tumors to postmasectomy radiation therapy or not was an uncomfortable position for most physicians. It is interesting that the Intergroup trial evaluating this strategy, which was headed by Lori Pierce, recently had to close because of accrual problems. Other trials presented in this book were supported more enthusiastically.

2. Physicians listen to their patients as well as read the medical literature.

For example, we consistently observe that a significant fraction of meeting attendees believe that tamoxifen causes weight gain (page 6) in spite of the clinical trial evidence contradicting this widely held belief.

3. News travels fast.

While it is likely that a physician attending a three-day meeting on breast cancer might be more informed than the average physician, it is fascinating how quickly key information is communicated. For example, last year — just months after Craig Allred's San Antonio presentation — most attendees were already incorporating ER assay measurements into management of women with DCIS. This year, the fraction of attendees ordering ER/PR measurements exceeded 90 percent (page 8).

4. Second opinions can be helpful.

The most interesting aspect of these data is the diversity of perspectives on challenging situations, which is quite understandable given the lack of solid evidence on which to base many decisions. It is sobering to consider how different a recommendation a patient might receive depending on which physician does the evaluation.

Our mission as a CME group is not to provide dogmatic answers for the many controversies in every stage of breast cancer management, but to heighten awareness of the spectrum of perspectives on these issues. The enclosed report documents the wide diversity of opinions on many key issues.

Neil Love, MD
NLove@ResearchToPractice.net