Quick Links

Share with Colleagues
Previous EBM Focus Issues
Become a DynaMed Reviewer
DynaMed Free Trial
Send Comment to Editor

Join Our Mailing List



Physicians: .25 AMA PRA Category I CreditsTM
Family Physicians: .25 Prescribed credits
Nurse Practitioners: .25 Contact hours

Release Date: September 10, 2014
Expiration Date: September 10, 2015

Estimated Completion Time: 15 minutes

There is no fee for this activity.

To Receive Credit

In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon above.

Program Overview

Learning Objectives

Upon successful completion of this educational program, the reader should be able to:

1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.

Faculty Information

Alan Ehrlich, MD
Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Senior Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP
Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company


Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.

No commercial support has been received for this activity.

Accreditation Statements

ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: This enduring material activity, DynaMed EBM Focus Volume 9, has been reviewed and is acceptable for up to 15.25 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 5, 2014. Term of approval is for one year from this date. Each EBM Focus is approved for .25 Prescribed credits. Credit may be claimed for one year from the date of each update. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AANP: This program is approved for 0.25 contact hour(s) of continuing education by the American Association of Nurse Practitioners. This program was planned in accordance with AANP CE Standards and Policies and AANP Commercial Support Standards.

Program ID: 1405237Q

Last week 550 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 213 articles were added to DynaMed content.

Based on criteria for selecting "articles most likely to change clinical practice," one article was selected by the DynaMed Editorial Team.

Bilateral Mastectomy May Not Increase Survival Compared to Breast-Conserving Surgery With Radiation in Women With Unilateral Breast Cancer
Reference: JAMA 2014 Sep 3;312(9):902 (level 2 [mid-level] evidence)

Bilateral mastectomy rates have been on the rise among women with early breast cancer in recent years (J Clin Oncol 2009 Sep 1;27(25):4-82, J Clin Oncol 2011 Jun 1;29(16):2158). However, while bilateral mastectomy has been shown to reduce the incidence of breast cancer in women at increased risk (Ann Oncol 2013 Aug;24(8):2029 full-text), the evidence is inconsistent for bilateral mastectomy as a treatment in women with unilateral breast cancer (Cochrane Database Syst Rev 2010 Nov 10;(11):CD002748). Furthermore, no randomized trials have been performed comparing bilateral mastectomy vs. breast-conserving surgery plus radiation. Many women with breast cancer have a preference for bilateral mastectomy based on its perceived benefits, and may object to randomization to less extensive surgery, making it difficult to conduct randomized trials for this particular comparison. A new population-based cohort study evaluated bilateral mastectomy, unilateral mastectomy, and breast-conserving surgery with radiation in 189,734 women with early (stage 0-III) unilateral breast cancer using data collected from 1998 to 2011 in the California Cancer Registry.

A total of 6.2% of women had bilateral mastectomy, 38.8% had unilateral mastectomy, and 55% had breast-conserving surgery with radiation. The overall rate of bilateral mastectomy increased during the study, ranging from 2% in 1998 to 12.3% in 2011. Factors most significantly associated with increased rate of bilateral mastectomy vs. breast-conserving surgery with radiation included age < 50 years, positive lymph node status, and lobular histology. However, data on other relevant information that may have influenced a treatment decision (such as magnetic resonance imaging or BRCA1 or BRCA2 gene mutation status) were not available from the registry.

There were no significant differences in the all-cause or breast cancer-specific mortality comparing bilateral mastectomy vs. breast-conserving surgery with radiation. Both approaches were associated with small but significant reductions in mortality compared to unilateral mastectomy. Estimated 10-year all-cause mortality was 16.8% with breast-conserving surgery with radiation, 18.8% with bilateral mastectomy, and 20.1% with unilateral mastectomy.

This study supports the use of breast-conserving surgery with radiation as the first line of treatment for women with early stage unilateral breast cancer. However, the lack of information on potential confounders, such as magnetic resonance imaging or gene mutation results, detailed patient history, and physician recommendations limit the ability to make definitive conclusions from the current data.

For more information see the Surgery for early and locally advanced breast cancer topic in DynaMed.

Earn CME Credit for reading this e-Newsletter. For more information on this educational activity, see the CME sidebar.

EBSCO Health Launches Pediatric Clinical Information Mobile App

PEMSoft Now Available For iPhone, iPad, and Android Devices

A mobile app designed specifically for pediatricians, emergency department physicians, physicians-in-training and other medical providers caring for children with acute illnesses and injury, is now available from EBSCO Health, the leading provider of clinical decision support solutions for the healthcare industry.

Designed by pediatricians, emergency physicians and other medical specialists, PEMSoft is a pediatric evidence-based point-of-care medical reference tool for hospitals, emergency departments, clinics, pediatric group practices, transport services, and medical schools. The vast content in PEMSoft addresses the entire spectrum of neonatal, infant, child, adolescent and young adult health. PEMSoft authors adhere to a strict evidence-based editorial policy focused on systematic identification, evaluation and consolidation of practice-changing clinical literature.

The PEMSoft Mobile app includes explicit step-by-step emergency critical care procedures, information about common pediatric signs and symptoms and content covering pediatric injuries and management approaches. More than 3,000 evidence-based pediatric topics and a similar number of medical illustrations, clinical images and videos are also available via the mobile app.

The PEMSoft Mobile App is accessible from both Apple and Android devices.

Visit the PEMSoft page for more information.

Call for Peer Reviews

We are currently seeking subspecialty reviewers for our Patient Education Resource Center (PERC). PERC provides fact sheets and discharge instructions for patients leaving the hospital or emergency room. These hand-outs fulfill the meaningful use requirements for the Medicare & Medicare Services Incentive Programs.

Click here to speak with us about becoming a peer reviewer.

DynaMed Contribution Opportunities

Become a DynaMed Resident Focus Reviewer
DynaMed Peer Review
Editorial Policies for Reviewers
Education for Clinicians in Training

DynaMed Careers

Looking for a change? The DynaMed editorial team is expanding and looking for talented and driven individuals. Visit the links below to learn about these exciting opportunities.

Section Editor of Specialty Content