American College of Surgeons and Commission on Cancer Release Lists of Commonly Used Tests and Treatments for Patients to Discuss With Their Surgeons

CHICAGO, IL (September 4, 2013):  The American College of Surgeons (ACS) and Commission on Cancer (CoC) today released separate lists of specific tests or procedures that are commonly ordered but not always necessary in surgery and surgical oncology as part of the Choosing Wisely® campaign, an initiative of the ABIM Foundation. The list from each organization identifies five targeted, evidence-based recommendations that can support conversations between patients and physicians about what care is really necessary.

The American College of Surgeons’ list set forth the following five recommendations:

  • Don’t perform axillary lymph node dissection for clinical stages I and II breast cancer with clinically negative lymph nodes without attempting sentinel node biopsy.
  • Avoid the routine use of “whole-body” diagnostic computed tomography (CT) scanning in patients with minor or single system trauma.
  • Avoid colorectal cancer screening tests on asymptomatic patients with a life expectancy of less than ten years and no family or personal history of colorectal neoplasia.
  • Avoid admission or preoperative chest x-rays for ambulatory patients with unremarkable history and physical exam.
  • Don’t do computed tomography (CT) for the evaluation of suspected appendicitis in children until after ultrasound has been considered as an option.

“These recommendations will help to enhance the patient-surgeon relationship and heighten the quality of care surgical patients receive, which is one of our highest priorities,” said David B. Hoyt, MD, FACS, ACS Executive Director.

The Commission on Cancer’s list set forth the following five recommendations:

  • Don’t perform surgery to remove a breast lump for suspicious findings unless needle biopsy cannot be done.
  • Don’t initiate surveillance testing after cancer treatment without providing the patient a survivorship care plan.
  • Don’t use surgery as the initial treatment without considering presurgical (neoadjuvant) systemic and/or radiation for cancer types and stage where it is effective at improving local cancer control, quality of life, or survival.
  • Don’t perform major abdominal surgery or thoracic surgery without a pathway or standard protocol for post-operative pain control and pneumonia prevention.
  • Don’t initiate cancer treatment without defining the extent of the cancer (through clinical staging) and discussing with the patient the intent of treatment.

“This initiative will help provide cancer patients with a highly credible resource to obtain reliable information when discussing certain aspects of their care with their physicians,” said David P. Winchester, MD, FACS, Medical Director, ACS Cancer Programs.

The American College of Surgeons and Commission on Cancer Choosing Wisely lists were developed after months of careful consideration and review, using current evidence about management and treatment options. The ACS solicited recommendations from the its Committee on Trauma, and its Advisory Councils for Colon and Rectal Surgery, General Surgery, and Pediatric Surgery, as well as the Commission on Cancer. All of the recommendations collected from the ACS committees and councils were reviewed, and five items were identified.

The CoC appointed a multidisciplinary task force to develop its list. Recommendations for candidate interventions were solicited from panel members and other leaders from the Commission on Cancer. The panel voted on each intervention to select the final list of recommended interventions.

“The American College of Surgeons and Commission on Cancer have shown tremendous leadership by releasing its list of tests and procedures they say are commonly done in surgery and surgical oncology, but aren’t always necessary,” said Richard J. Baron, MD, president and CEO of the ABIM Foundation. “The content of these lists and all of the others developed through this effort are helping physicians and patients across the country engage in conversations about what care they need, and what we can do to reduce waste and overuse in our health care system.”

NOTE: The American College of Surgeons and Commission on Cancer lists are posted online at:

Over the next year, more than 30 other specialty society partners will release Choosing Wisely lists, including:

  • September 4, 2013 – AMDA – Dedicated to Long Term Care Medicine
  • September 11, 2013 – American Academy of Orthopaedic Surgeons
  • September 12, 2013 – Society of General Internal Medicine
  • September 20, 2013 – American Psychiatric Association
  • September 23, 2013 – American Society for Radiation Oncology
  • September 24, 2013 – American Academy of Family Physicians**
  • September 26, 2013 – American College of Medical Toxicology and the American Academy of Clinical Toxicology
  • October 8, 2013 – American Association for Pediatric Ophthalmology and Strabismus
  • October 9, 2013 – North American Spine Society
  • October 14, 2013 – American College of Emergency Physicians
  • October 16, 2013 – American Association of Clinical Endocrinologists/The Endocrine Society
  • October 27, 2013 – American College of Chest Physicians/American Thoracic Society (Pulmonary)
  • October 27, 2013 – American College of Rheumatology*
  • October 29, 2013 – American Academy of Dermatology
  • October 29, 2013 – American Society of Clinical Oncology*
  • October 31, 2013 – Society of Gynecologic Oncology
  • November 21, 2013 – American Headache Society
  • December 4, 2013 – American Society of Hematology
  • January 11, 2014 – American Association of Critical-Care Nurses/American College of Chest Physicians/American Thoracic Society/Society of Critical Care Medicine (Critical Care)
  • January 16, 2014  – Society for Cardiovascular Magnetic Resonance
  • February 3, 2014 – Society for Maternal-Fetal Medicine
  • February 10, 2014  – Heart Rhythm Society
  • February 24, 2014 – American College of Occupational and Environmental Medicine
  • February 27, 2014 – American Geriatrics Society*
  • February 28, 2014 – American Academy of Allergy, Asthma & Immunology
  • TBD – American Association of Neurological Surgeons
  • TBD – American Society of Anesthesiologists
  • TBD – American Society of Colon and Rectal Surgeons

* Releasing a second list ** Releasing a third list

To date, over 80 national and state medical specialty societies, regional health collaboratives and consumer partners have joined the conversations about appropriate care. With the release of these new lists, the campaign will have covered more than 250 tests and procedures that the specialty society partners say are overused and inappropriate, and that physicians and patients should discuss.

The campaign also continues to reach millions of consumers nationwide through a stable of consumer and advocacy partners, led by Consumer Reports—the world’s largest independent product-testing organization—which has worked with the ABIM Foundation to distribute patient-friendly resources for consumers and physicians to engage in these important conversations.

To learn more about Choosing Wisely and to view the complete lists and additional detail about the recommendations and evidence supporting them, visit