Author's reply: Lessons learned in breast cancer surgery (Br J Surg2014; 101: 145-147)

What is it about?

It is very encouraging when one's publication is greeted with approbation rather than brickbats and I thank Dr Arora for his thoughtful comments. I have been very lucky to spend most of my working life in a Centre of Excellence where multidisciplinary working has been the norm for the management of all our patients with breast cancer. Others have been less fortunate. We were aware through medicolegal practice that management of breast cancer was haphazard in certain nearby institutions and others far afield, and more guided by surgical whim than evidence‐based protocols. The Cancer Plan and its aftermath have succeeded in establishing peer‐reviewed multidisciplinary teams throughout the UK. The multidisciplinary team is the major component in the drive to reduce unnecessary cancer deaths. Although appreciating that geographical and political considerations may make the introduction of multidisciplinary teams more difficult to achieve in India, this is not an insuperable task. They do represent a relatively inexpensive and cost‐effective means of avoiding unnecessary surgery or inadequate systemic therapy. In isolated areas teleconferencing may provide the means of avoiding excessive time spent in travel and provide the necessary support and forum for overburdened clinicians.

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