Commission on Cancer

View all recommendations from this society

Released September 4, 2013

Don’t use surgery as the initial treatment without considering pre-surgical (neoadjuvant) systemic and/or radiation for cancer types and stage where it is effective at improving local cancer control, quality of life or survival.

  • In many cancer types, presurgical chemotherapy, hormone/endocrine therapy and/or radiation therapy followed by surgery is better than surgery as the first treatment. This often shrinks the cancer, allowing more limited surgery that maintains organ function, reduces the chances of cancer recurrence and spread, and improves the quality of life.
  • For example, pre-surgical therapy may make mastectomy unnecessary with breast cancer, a colostomy unnecessary with rectal cancer, voice-sparing surgery possible with laryngeal cancer and amputation unnecessary with extremity soft tissue sarcoma.
  • When used appropriately, there is no evidence that the cancer spreads during pre-surgical therapy and that cancer survival is the same or better as with initial surgery.
  • Despite its known advantages, many people are not provided the advantages of pre-surgical therapy.
  • Disease sites where this should be considered include:
    • Clinical Stage IIB and IIIA Non Small Cell Lung Cancer
    • Clinical T2-4a; Any N positive esophageal cancer
    • Clinical T3 and T4 rectal cancer
    • Clinical T2, T3 or Stage III breast cancer
    • Head and Neck cancer
    • Resectable pancreas cancer
    • Extremity soft tissue sarcomas where resection may affect functional outcomes.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American College of Surgeons concluded in its review of this opportunity that it was optimal to submit a separate list of interventions related to cancer from the American College of Surgeons Commission on Cancer. The Commission on Cancer appointed a multidisciplinary task force that met in person in September, 2012 and subsequently by conference call and electronic communications.

Recommendations for candidate interventions were solicited from panel members and other leaders from the Commission on Cancer. These panel members were provided a written charge to identify measures that would support the Commission’s standards for accreditation in use in more than 1,500 cancer programs across the U.S. In addition, panel members were provided with a full description of the Choosing Wisely®campaign and the interventions previously recommended by other organizations both for cancer and all other disorders.

Following initial submission of the candidate interventions, the panel discussed each intervention specifically evaluating the significance of the intervention, the potential scope of variation in care affected by the intervention, and the potential numbers of persons affected by this. The group also discussed the impact on short-term and long-term cost to be gained by implementation of each intervention. The panel voted on each intervention to select the final list of recommended interventions. The panel members then reviewed and refined the wording of each intervention and completed the bulleted supporting documentation and literature citations. The final list of interventions was then approved by the panel and submitted to the leadership of the American College of Surgeons for final approval. The Commission on Cancer’s disclosure and conflict of interest policy can be found at

Commission on Cancer Panel Members

  • Stephen Edge, MD, FACS, Chair, Roswell Park Cancer Institute, Buffalo, NY
  • David Bentrem, MD, FACS, Northwestern Memorial Hospital, Chicago, IL
  • Daniel Kollmorgen, MD, FACS, University of Iowa, Des Moines, IA
  • Daniel McKellar, MD, FACS, Wayne Healthcare, Greenville, OH
  • Christopher Pezzi, MD, FACS, Abington Memorial Hospital, Abington, PA
  • Lee Wilke, MD, FACS, University of Wisconsin Health System, Madison, WI
  • David Winchester, MD, FACS, Medical Director, Cancer Programs, American College of Surgeons


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