Fisher's work led doctors to move from radical mastectomies to, in some cases, lumpectomies for women with breast cancer.

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Richard Winder, deputy national coordinator of NHS cancer screening programmes, said a minority of British women with the disease had mastectomies.

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So seen over longer there are more mastectomies in the screened areas.

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Mr Paterson is accused of performing "cleavage-sparing" mastectomies at Solihull Hospital and two private hospitals owned by Spire Healthcare in Solihull and Little Aston, Staffordshire.

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Among other limitations of the studies: Patients whose claims were analyzed in the MD Anderson study weren't randomized to either treatment, nor did researchers know why patients had mastectomies.

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Similarly, author Siddhartha Mukherjee details how hundreds of thousands of women had radical mastectomies despite a total lack of evidence that this surgery is the best treatment for most patients.

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Nevertheless, the association is promulgating a code that prohibits its 1, 000 member HMOs from enforcing gag rules and employing such practices as drive-by mastectomies, on pain of being kicked out.

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"Ostomies, like mastectomies, save lives, period, " he said.

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Musgrave thinks the medical community has to work to educate patients about reconstructive surgery before mastectomies and other surgeries are performed to help them to make well-informed decisions, something that is not legislated in Canada.

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