虽然将近一半女性患有良性乳腺疾病，但是与乳腺癌相比，目前缺乏高水平证据以指导治疗。因此，良性乳腺疾病处理主要依靠个别医师的经验和培训。2012年，美国内科医学委员会发起了明智选择运动，促进患者与医师之间的对话，对可能不必要的诊疗提出质疑。美国乳腺外科医师学会患者安全与医疗质量委员会决定参与该运动，并于2018年美国乳腺外科医师学会第19届年会公布良性乳腺疾病明智选择。
2018年7月2日，美国乳腺外科医师学会和肿瘤外科学会官方期刊《肿瘤外科学年鉴》在线发表纽约哥伦比亚大学、印第安纳大学、奥克兰湾区乳腺外科医师协会、路易斯维尔诺顿外科医师协会、安妮阿伦德尔医疗中心、梅奥医学中心、杜克大学、森塔拉综合乳腺中心、麦迪逊威斯康星大学、纽约西奈山医疗集团、迈阿密癌症研究所、伯明翰阿拉巴马大学、佛蒙特大学、辛辛那提癌症研究所、冈德森医学基金会起草的良性乳腺疾病明智选择：美国乳腺外科医师学会响应美国内科医学委员会明智选择运动的倡议。
首先，患者安全与医疗质量委员会征求最初的候选措施，外科医师提交各种做法，由此产生的28项措施通过两轮改良德尔菲法进行评级。最终清单得到美国乳腺外科医师学会批准，并且得到美国内科医学委员会认可。最终确定5项措施概括如下：
不常规手术切除无症状患者的乳腺假血管瘤样间质增生区域。
不常规手术切除经活检证实而且小于两厘米的乳腺纤维腺瘤。
不常规手术治疗乳腺脓肿，首先尝试经皮抽吸。
不对预期寿命少于五年的体检正常无症状患者进行乳腺钼靶检查。
不常规引流无痛液性乳腺囊肿。
美国乳腺外科医师学会明智选择措施旨在解决良性乳腺疾病处理，患者安全与医疗质量委员会对这些推荐意见达成共识，这些措施为医患共同决策提供指导，患者可以通过互联网方便获取。
Ann Surg Oncol. 2018 Jul 2. [Epub ahead of print]
Select Choices in Benign Breast Disease: An Initiative of the American Society of Breast Surgeons for the American Board of Internal Medicine Choosing Wisely Campaign.
Roshni Rao, Kandace Ludwig, Lisa Bailey, Tiffany S. Berry, Robert Buras, Amy Degnim, Oluwadamilola M. Fayanju, Joshua Froman, Negar Golesorkhi, Caprice Greenburg, Ayemoe Thu Ma, Starr Koslow Mautner, Helen Krontiras, Michelle Sowden, Barbara Wexelman, Jeffrey Landercasper.
Columbia University Medical Center, New York, USA; University of Indiana, Indianapolis, USA; Bay Area Breast Surgeons, Oakland, USA; Norton Surgical Specialists, Louisville, USA; Anne Arundel Medical Center, Annapolis, USA; Mayo Clinic, Rochester, USA; Duke University, Durham, USA; Mayo Clinic Health System, Owatonna, USA; Sentara Comprehensive Breast Center, Lorton, USA; University of Wisconsin, Madison, USA; Mount Sinai Health System, New York, USA; Miami Cancer Institute, Miami, USA; University of Alabama, Birmingham, USA; The University of Vermont Medical Center, Burlington, USA; Trihealth Cancer Institute, Cincinnati, USA; Gundersen Medical Foundation, La Crosse, USA.
BACKGROUND: Up to 50% of all women encounter benign breast problems. In contrast to breast cancer, high-level evidence is not available to guide treatment. Management is therefore largely based on individual physician experience/training. The American board of internal medicine (ABIM) initiated its Choosing Wisely campaign to promote conversations between patients and physicians about challenging the use of tests or procedures which may not be necessary. The American society of breast surgeons (ASBrS) Patient safety and quality committee (PSQC) chose to participate in this campaign in regard to the management of benign breast disease.
METHODS: The PSQC solicited initial candidate measures. PSQC surgeons represent a wide variety of practices. The resulting measures were ranked by modified Delphi appropriateness methodology in two rounds. The final list was approved by ASBrS and endorsed by the ABIM.
RESULTS: The final five measures are as follows. (1) Don't routinely excise areas of pseuodoangiomatous stromal hyperplasia (PASH) of the breast in patients who are not having symptoms from it. (2) Don't routinely surgically excise biopsy-proven fibroadenomas that are < 2 cm. (3) Don't routinely operate for a breast abscess without an initial attempt to percutaneously aspirate. (4) Don't perform screening mammography in asymptomatic patients with normal exams who have less than a 5-years life expectancy. (5) Don't routinely drain nonpainful, fluid-filled cysts.
CONCLUSIONS: The ASBrS Choosing Wisely measures that address benign breast disease management are easily accessible to patients via the internet. Consensus was reached by PSQC regarding these recommendations. These measures provide guidance for shared decision-making.
DOI: 10.1245/s10434-018-6584-5
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