51
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Paraskeva N, Herring B, Tollow P, Harcourt D. First look: A mixed-methods study exploring women's initial experiences of their appearance after mastectomy and/or breast reconstruction✰. J Plast Reconstr Aesthet Surg 2019; 72:539-547. [DOI: 10.1016/j.bjps.2019.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/30/2018] [Accepted: 01/06/2019] [Indexed: 10/27/2022]
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52
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Mukherjee SD, Hodgson N, Lovrics PJ, Dhamanaskar K, Chambers S, Sussman J. Surgical attitudes toward preoperative breast magnetic resonance imaging in women with early-stage breast cancer. ACTA ACUST UNITED AC 2019; 26:e194-e201. [PMID: 31043827 DOI: 10.3747/co.26.4227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Preoperative breast magnetic resonance imaging (mri) is commonly requested by surgeons in the initial workup of women with breast cancer; however, its use is controversial. We performed a survey of breast cancer surgeons across Canada to investigate current knowledge about, attitudes to, and self-reported use of preoperative breast mri in a publicly funded health care system in light of the limited evidence to support it. Methods All identified general surgeons in Canada were mailed a survey instrument designed to probe current practice and knowledge of published trials. Results Of 403 responding surgeons, 233 (58%) indicated that they performed breast cancer surgery. Of those 233, 218 (94%) had access to breast mri and completed the entire survey. Overall, 54.6% of responding surgeons felt that breast mri was useful in surgical planning, and more than half (58.3%) indicated that their frequency of use was likely to increase over the next 5 years. Surgeons found preoperative mri most useful in detecting mammographically occult disease (71.5% of respondents) and in planning for breast-conserving surgery (57.3%). The main limitations reported were timely access to mri (51%) and false positives (36.7%). Responses suggest a knowledge gap in awareness of published trials in breast mri. Conclusions Our study found that, in early-stage breast cancer, self-reported use of mri by breast cancer surgeons in Canada varied widely. Reported indications did not align with published data, and significant gaps in self-reported knowledge of the data were evident. Our results would support the development and dissemination of guidelines to optimize use of mri.
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Affiliation(s)
| | - N Hodgson
- Juravinski Cancer Centre, Hamilton, ON.,Juravinski Hospital, Hamilton, ON
| | | | | | | | - J Sussman
- Juravinski Cancer Centre, Hamilton, ON.,McMaster University, Hamilton, ON
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53
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van Bommel A, Spronk P, Mureau M, Siesling S, Smorenburg C, Tollenaar R, Vrancken Peeters MJ, van Dalen T. Breast-Contour-Preserving Procedure as a Multidisciplinary Parameter of Esthetic Outcome in Breast Cancer Treatment in The Netherlands. Ann Surg Oncol 2019; 26:1704-1711. [PMID: 30830541 PMCID: PMC6510878 DOI: 10.1245/s10434-019-07265-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND The rate of breast-conserving surgery (BCS) is used as an esthetic outcome parameter, while other treatments contribute also, such as neoadjuvant chemotherapy (NAC) enabling BCS or immediate breast reconstruction (IBR). This study explores these efforts to preserve the patient's breast contour. PATIENTS AND METHODS All patients who underwent surgery for invasive breast cancer in The Netherlands between January 2011 and December 2015 were selected from the Dutch national breast cancer audit (n = 61,309). The breast-contour-preserving procedures (BCPP) rate was defined as the rate of primary BCS, BCS after NAC, or mastectomy with IBR. BCPP rates were calculated and compared by year of diagnosis, age categories, and individual hospitals. RESULTS The rate of primary BCS remained stable (53%) while the BCPP rate increased from 63% in 2011 to 71% in 2015 due to an increase in patients receiving BCS after NAC and mastectomy with IBR. Primary BCS rates increased with age (from 17% in patients aged < 30 years to 63% in patients aged 60-69 years), while the proportion of patients undergoing mastectomy with IBR decreased from 44% in patients < 30 years to 1% in patients ≥ 70 years. The BCPP rate was similar for all age groups except for patients > 70 years. BCPP rates varied between the different hospitals in The Netherlands, ranging from 47 to 88%. CONCLUSIONS The chance of preserving the breast contour for patients with breast cancer has increased substantially over recent years. BCPP provides a comprehensive parameter of esthetic outcome of breast cancer surgery.
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Affiliation(s)
- Annnelotte van Bommel
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands. .,Dutch Institute for Clinical Auditing, Leiden, The Netherlands.
| | - Pauline Spronk
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.,Dutch Institute for Clinical Auditing, Leiden, The Netherlands
| | - Marc Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.,Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Carolien Smorenburg
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Rob Tollenaar
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.,Dutch Institute for Clinical Auditing, Leiden, The Netherlands
| | | | - Thijs van Dalen
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
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54
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Bloom DL, Chapman BM, Wheeler SB, McGuire KP, Lee CN, Weinfurt K, Rosenstein DL, Plichta JK, Jacobson Vann JC, Hwang ES. Reframing the conversation about contralateral prophylactic mastectomy: Preparing women for postsurgical realities. Psychooncology 2018; 28:394-400. [PMID: 30500102 DOI: 10.1002/pon.4955] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/20/2018] [Accepted: 11/26/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Women with unilateral, early-stage breast cancer and low genetic risk are increasingly opting for contralateral prophylactic mastectomy (CPM), a concerning trend because CPM offers few clinical benefits while increasing risks of surgical complications. Few qualitative studies have analyzed factors motivating this irreversible decision. Using qualitative methods, this study sought to understand women's decision making and the impact of CPM on self-confidence, sense of femininity, sexual intimacy, and peace of mind. METHODS Women who had CPM within the last 10 years were recruited to participate in the study. We conducted a thematic analysis of the data. RESULTS Forty-five women were interviewed. When making the decision for CPM, most had incomplete knowledge of potential negative outcomes. However, all believed CPM had more benefits than harms and would confer the most peace of mind and the fewest regrets should cancer return. They knew their contralateral breast cancer risk was low but were not persuaded by statistics. They wanted to do everything possible to reduce their risk of another breast cancer, even by a minimal amount, but most reported paying an unexpectedly high price for this small reduction in risk. Nevertheless, 41 of 45 reported that they would make the same decision again. CONCLUSIONS These findings highlight an opportunity for physicians to reframe the conversation to focus on the patient experience of the tradeoffs of CPM rather than statistical odds of future cancers. Our findings suggest that more data may not dissuade women from CPM but may better prepare them for its outcomes.
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Affiliation(s)
- Diane L Bloom
- Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brittany M Chapman
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Stephanie B Wheeler
- Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kandace P McGuire
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Clara N Lee
- Department of Plastic Surgery, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Kevin Weinfurt
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Donald L Rosenstein
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, North Carolina.,Department of Surgery, Duke Cancer Institute, Durham, North Carolina
| | - Julie C Jacobson Vann
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, North Carolina.,Department of Surgery, Duke Cancer Institute, Durham, North Carolina
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55
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Pollom EL, Qian Y, Chin AL, Dirbas FM, Asch SM, Kurian AW, Horst KC, Tsai CJ. Rising rates of bilateral mastectomy with reconstruction following neoadjuvant chemotherapy. Int J Cancer 2018; 143:3262-3272. [PMID: 29992582 PMCID: PMC6263854 DOI: 10.1002/ijc.31747] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 06/08/2018] [Accepted: 06/19/2018] [Indexed: 01/04/2023]
Abstract
Neoadjuvant chemotherapy (NAC) is used to allow more limited breast surgery without compromising local control. We sought to evaluate nationwide surgical trends in patients with operable breast cancer treated with NAC and factors associated with surgical type. We used the National Cancer Database to identify 235,339 women with unilateral T1-3 N0-3 M0 breast cancer diagnosed between 2010 and 2014 and treated with surgery and chemotherapy. Of these, 59,568 patients (25.3%) were treated with NAC. Rates of pathological complete response (pCR) to NAC increased from 33.3% at the start of the study period in 2010 to 46.3% at the end of the period in 2014 (p = 0.02). Rates of breast-conserving surgery (BSC) changed little, from 37.0 to 40.8% (p = 0.22). Although rates of unilateral mastectomy decreased from 43.3 to 34.7% (p = 0.02) and rates of bilateral mastectomy without immediate reconstruction remained similar (11.7-11.5%; p = 0.82), rates of bilateral mastectomy with immediate reconstruction rose from 8.0 to 13.1% (p = 0.02). Patients who were younger, with private/managed care insurance, and diagnosed in more recent years were more likely to achieve pCR; however, these same characteristics were associated with receipt of bilateral mastectomy (vs. BCS). In addition, non-Hispanic white ethnic and higher area education attainment were both associated with bilateral mastectomy. These findings did not differ by age or molecular subtype. Further study of nonclinical factors that influence selection of more extensive surgery despite excellent response to NAC is warranted.
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Affiliation(s)
- Erqi L Pollom
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Yushen Qian
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Alexander L Chin
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | | | - Steven M Asch
- Division of Primary Care and Population Health, Stanford University, Stanford, CA
| | - Allison W Kurian
- Department of Medicine (Oncology) and Health Research and Policy, Stanford University, Stanford, CA
| | - Kathleen C Horst
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - C Jillian Tsai
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
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56
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Bleicher RJ, Chang C, Wang CE, Goldstein LJ, Kaufmann CS, Moran MS, Pollitt KA, Suss NR, Winchester DP, Tafra L, Yao K. Treatment delays from transfers of care and their impact on breast cancer quality measures. Breast Cancer Res Treat 2018; 173:603-617. [DOI: 10.1007/s10549-018-5046-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 11/08/2018] [Indexed: 11/25/2022]
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57
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Rzepecki AK, Wang J, Urman A, Amin B, McLellan B. Nummular eczema of the breast following surgery and reconstruction in breast cancer patients. Acta Oncol 2018; 57:1586-1588. [PMID: 30014750 DOI: 10.1080/0284186x.2018.1489145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Alexandra K. Rzepecki
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
- Montefiore Medical Center, Department of Medicine, Division of Dermatology, Bronx, NY, USA
| | - Jenny Wang
- Department of Dermatology, New York University School of Medicine, New York, NY, USA
| | - Alexandra Urman
- Department of Oncology, Montefiore Medical Center, Bronx, NY, USA
| | - Bijal Amin
- Montefiore Medical Center, Department of Medicine, Division of Dermatology, Bronx, NY, USA
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Beth McLellan
- Montefiore Medical Center, Department of Medicine, Division of Dermatology, Bronx, NY, USA
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58
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Mazor AM, Mateo AM, Demora L, Sigurdson ER, Handorf E, Daly JM, Aggon AA, Anderson PR, Weiss SE, Bleicher RJ. Breast conservation versus mastectomy in patients with T3 breast cancers (> 5 cm): an analysis of 37,268 patients from the National Cancer Database. Breast Cancer Res Treat 2018; 173:301-311. [PMID: 30343456 DOI: 10.1007/s10549-018-5007-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 10/09/2018] [Indexed: 01/25/2023]
Abstract
PURPOSE Breast conservation therapy (BCT) is standard for T1-T2 tumors, but early trials excluded breast cancers > 5 cm. This study was performed to assess patterns and outcomes of BCT for T3 tumors. METHODS We reviewed the National Cancer Database (NCDB) for noninflammatory breast cancers > 5 cm, between 2004 and 2011 who underwent BCT or mastectomy (Mtx) with nodal evaluation. Patients with skin or chest wall involvement were excluded. Patients having clinical T3 tumors were analyzed to determine outcomes based upon presentation, with those having pathologic T3 tumors, subsequently assessed, irrespective of presentation. Overall survival (OS) was analyzed using multivariable Cox proportional hazards models, with adjusted survival curves estimated using inverse probability weighting. RESULTS After exclusions, 37,268 patients remained. Median age and tumor size for BCT versus Mtx were 53 versus 54 years (p < 0.001) and 6.0 versus 6.7 cm (p < 0.001), respectively. Predictors of BCT included age, race, location, facility type, year of diagnosis, tumor size, grade, histology, nodes examined and positive, and administration of chemotherapy and radiotherapy. OS was similar between Mtx and BCT (p = 0.36). This held true when neoadjuvant chemotherapy patients were excluded (p = 0.39). BCT percentages declined over time (p < 0.001), while tumor sizes remained the same (p = 0.77). Median follow-up was 51.4 months. CONCLUSIONS OS for patients with T3 breast cancers is similar whether patients received Mtx or BCT, confirming that tumor size should not be an absolute BCT exclusion. Declining use of BCT for tumors > 5 cm in younger patients may be accounted for by recent trends toward mastectomy.
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Affiliation(s)
- Anna M Mazor
- Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Room C-308, Philadelphia, PA, 19111, USA
| | - Alina M Mateo
- Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Room C-308, Philadelphia, PA, 19111, USA
| | - Lyudmila Demora
- Department of Biostatistics, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Elin R Sigurdson
- Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Room C-308, Philadelphia, PA, 19111, USA
| | - Elizabeth Handorf
- Department of Biostatistics, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - John M Daly
- Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Room C-308, Philadelphia, PA, 19111, USA
| | - Allison A Aggon
- Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Room C-308, Philadelphia, PA, 19111, USA
| | - Penny R Anderson
- Departments of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Stephanie E Weiss
- Departments of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Richard J Bleicher
- Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Room C-308, Philadelphia, PA, 19111, USA.
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59
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Rosenkranz KM, Ballman K, McCall L, Kubicky C, Cuttino L, Le-Petross H, Hunt KK, Giuliano A, Van Zee KJ, Haffty B, Boughey JC. The Feasibility of Breast-Conserving Surgery for Multiple Ipsilateral Breast Cancer: An Initial Report from ACOSOG Z11102 (Alliance) Trial. Ann Surg Oncol 2018; 25:2858-2866. [PMID: 29987605 PMCID: PMC6192830 DOI: 10.1245/s10434-018-6583-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Historically, multiple ipsilateral breast cancer (MIBC) has been a contraindication to breast-conserving therapy (BCT). We report the feasibility of BCT in MIBC from the ACOSOG Z11102 trial [Alliance], a single arm noninferiority trial of BCT for women with two or three sites of malignancy in the ipsilateral breast. METHODS Women who enrolled preoperatively in ACOSOG Z11102 were evaluated for conversion to mastectomy and need for reoperation to obtain negative margins. Characteristics of women who successfully underwent BCT and those who converted to mastectomy were compared. Factors were examined for association with the need for margin reexcision. RESULTS Of 198 patients enrolled preoperatively, 190 (96%) had 2 foci of disease. Median size of the largest tumor focus was 1.5 (range 0.1-7.0) cm; 49 patients (24.8%) had positive nodes. There were 14 women who underwent mastectomy due to positive margins, resulting in a conversion to mastectomy rate of 7.1% (95% confidence interval [CI] 3.9-10.6%). Of 184 patients who successfully completed BCT, 134 completed this in a single operation. Multivariable logistic regression analysis did not identify any factors significantly associated with conversion to mastectomy or need for margin reexcision. CONCLUSIONS Breast conservation is feasible in MIBC with 67.6% of patients achieving a margin-negative excision in a single operation and 7.1% of patients requiring conversion to mastectomy due to positive margins. No characteristic was identified that significantly altered the risk of conversion to mastectomy or need for reexcision. CLINICALTRIALS. GOV IDENTIFIER NCT01556243.
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Affiliation(s)
| | - Karla Ballman
- Alliance Statistics and Data Center, Weill Medical College of Cornell University, New York, NY, USA
| | - Linda McCall
- Alliance Statistics and Data Center, Duke University, Durham, NC, USA
| | | | - Laurie Cuttino
- Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Huong Le-Petross
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kelly K Hunt
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Bruce Haffty
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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60
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Campbell I, Lao C, Blackmore T, Edwards M, Hayes L, Ng A, Lawrenson R. Surgical treatment of early stage breast cancer in the Auckland and Waikato regions of New Zealand. ANZ J Surg 2018; 88:1263-1268. [DOI: 10.1111/ans.14840] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/01/2018] [Accepted: 08/04/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Ian Campbell
- School of Medicine; The University of Auckland; Auckland New Zealand
- Waikato District Health Board; Hamilton New Zealand
| | - Chunhuan Lao
- Medical Research Centre, University of Waikato; Hamilton New Zealand
| | - Tania Blackmore
- Medical Research Centre, University of Waikato; Hamilton New Zealand
| | - Melissa Edwards
- School of Medicine; The University of Auckland; Auckland New Zealand
| | - Louise Hayes
- Waikato District Health Board; Hamilton New Zealand
| | - Alex Ng
- Department of General Surgery, Auckland City Hospital; Auckland New Zealand
| | - Ross Lawrenson
- Waikato District Health Board; Hamilton New Zealand
- Medical Research Centre, University of Waikato; Hamilton New Zealand
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61
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van Maaren MC, Strobbe LJA, Koppert LB, Poortmans PMP, Siesling S. Nationwide population-based study of trends and regional variation in breast-conserving treatment for breast cancer. Br J Surg 2018; 105:1768-1777. [DOI: 10.1002/bjs.10951] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/06/2018] [Accepted: 06/21/2018] [Indexed: 12/20/2022]
Abstract
Abstract
Background
Landmark trials have shown breast-conserving surgery (BCS) combined with radiotherapy to be as safe as mastectomy in breast cancer treatment. This population-based study aimed to evaluate trends in BCS from 1989 to 2015 in nine geographical regions in the Netherlands.
Methods
All women diagnosed between 1989 and 2015 with primary T1–2 N0–1 breast cancer, treated with BCS or mastectomy, were identified from the Netherlands Cancer Registry. Crude and case mix-adjusted rates of BCS were evaluated and compared between nine Dutch regions for two time intervals: 1989–2002 and 2003–2015. The annual percentage change in BCS per region over time was assessed by means of Joinpoint regression analyses. Explanatory variables associated with the choice of initial surgery were evaluated using multivariable logistic regression.
Results
A total of 202 934 patients were included, 82 200 treated in 1989–2002 and 120 734 in 2003–2015. During 1989–2002, the mean rate of BCS was 50·6 per cent, varying significantly from 39·0 to 71·7 per cent between the nine regions. For most regions, a marked rise in BCS was observed between 2002 and 2003. During 2003–2015, the mean rate of BCS increased to 67·4 per cent, but still varied significantly between regions from 58·5 to 75·5 per cent. A significant variation remained after case-mix correction.
Conclusion
This large nationwide study showed that the use of BCS increased from 1989 to 2015 in the Netherlands. After adjustment for explanatory variables, a large variation still existed between the nine regions. This regional variation underlines the need for implementation of a uniform treatment and decision-making strategy.
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Affiliation(s)
- M C van Maaren
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - L J A Strobbe
- Department of Surgical Oncology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - L B Koppert
- Department of Surgical Oncology, Erasmus Medical Centre Cancer Institute, Rotterdam, The Netherlands
| | - P M P Poortmans
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - S Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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Brennan SB, D'Alessio D, Kaplan J, Edelweiss M, Heerdt AS, Morris EA. Positive predictive value of biopsy of palpable masses following mastectomy. Breast J 2018; 24:789-797. [PMID: 30033648 DOI: 10.1111/tbj.13037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 09/01/2017] [Accepted: 09/13/2017] [Indexed: 01/02/2023]
Abstract
Determine the positive predictive value (PPV) of biopsy of palpable masses following mastectomy (MX). Determine if there are patient characteristics, tumor, or imaging features more predictive of cancer. IRB-approved retrospective review of 16 396 breast ultrasounds June 2008-December 2015 identified patients with MX presenting with palpable masses. Medical records and imaging studies were reviewed. Statistical analysis was performed using Fisher's exact test. 95% confidence intervals (CI) were calculated. In all, 117 patients presented with palpable masses on the MX side. 101/117 patients who had a palpable mass on physical examination had a true sonographic mass to correlate with the clinical findings. 91/101 (90%) underwent biopsy: 19/91 (21%, 95% CI; 13-31) biopsies were malignant. 72/91 (79%) were benign. All 19 cancers were on the original cancer side. Recurrences ranged from 0.4 to 4.5 cm maximum diameter, mean 1.3 cm. Prophylactic vs therapeutic mastectomy was very statistically significant (P = .01). The use of tamoxifen or an AI was also statistically significant (P = .04). Patient age (P = 1.0), radiation therapy (P = 1.05), chemotherapy (P = .2), immediate breast reconstruction (P = .2), or implant vs flap (P = .2) had no statistically significant association with finding cancer on biopsy. Lesion shape (irregular vs oval/round) was highly statistically significant (P = .0003) as was non-parallel orientation on ultrasound (P = .008). Circumscribed vs non-circumscribed margins was also statistically significant (P = .008). The PPV of biopsy of palpable masses on the side of MX was 21% (95% CI; 13-31). All recurrences were on the original cancer side and this was very statistically significant.
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Affiliation(s)
- Sandra B Brennan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Donna D'Alessio
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jennifer Kaplan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marcia Edelweiss
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexandra S Heerdt
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elizabeth A Morris
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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63
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Zhang X, Wang Y. A survey of current surgical treatment of early stage breast cancer in China. Oncoscience 2018; 5:239-247. [PMID: 30234145 PMCID: PMC6142897 DOI: 10.18632/oncoscience.445] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/22/2018] [Indexed: 02/06/2023] Open
Abstract
The purpose of this national survey is to explore the patterns of surgical management for early stage breast cancer patients in China. A paper questionnaire survey was sent to the representatives from 520 hospitals who attended an international symposium in Guangzhou, China, 2014. The questionnaire included demographic information, initials and most preferred approaches for breast cancer surgery. The results were presented descriptively. The response rate was 42.5%. Only 7% of hospitals with >50% rate of breast conserving surgery (BCS). Intraoperative frozen sections and additional cavity margins assessment were used at 88% and 30.9% of hospitals, respectively. For invasive carcinoma, 15% of participants defined an adequate margin as no tumor cells on the ink. Sentinel lymph node biopsy (SLNB) was routinely performed in 93.2% of hospitals. Only 16.6% of hospitals would embrace the conclusions of the American College of Surgeons Oncology Group (ACOSOG) Z0011 study and omit axillary lymph node dissection (ALND) for patients who fit the Z0011 criteria. The current patterns for the management of breast cancer patients are still lagging behind. Chinese doctors need to catch up with the updated results of the cutting-edge clinical studies and multiple measures are in need to improve this situation.
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Affiliation(s)
- Xin Zhang
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Ying Wang
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
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Farhadihosseinabadi B, Hosseini F, Larki P, Bagheri N, Abbaszadeh-Goudarzi K, Sinehsepehr K, Johari B, Abdollahpour-Alitappeh M. Breast Cancer: Risk Factors, Diagnosis and Management. MEDICAL LABORATORY JOURNAL 2018. [DOI: 10.29252/mlj.12.5.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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65
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Abstract
Breast-conserving surgery (BCS) followed by radiation therapy is the current standard of care for early stage breast cancer. Successful BCS necessitates complete tumor resection with clear margins at the pathologic assessment of the specimen ("no ink on tumor"). The presence of positive margins warrants additional surgery to obtain negative final margins, which has significant physical, psychological, and financial implications for the patient. The challenge lies in developing accurate real-time intraoperative margin assessment techniques to minimize the presence of "ink on tumor" and the subsequent need for additional surgery.
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66
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Lee CNH, Pignone MP, Deal AM, Blizard L, Hunt C, Huh R, Liu YJ, Ubel PA. Accuracy of Predictions of Patients With Breast Cancer of Future Well-being After Immediate Breast Reconstruction. JAMA Surg 2018; 153:e176112. [PMID: 29417143 DOI: 10.1001/jamasurg.2017.6112] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Making a good decision about breast reconstruction requires predicting how one would feel after the procedure, but people tend to overestimate the impact of events on future well-being. Objective To assess how well patients predict future well-being after mastectomy, with or without immediate reconstruction, with the following a priori hypotheses: Patients will overestimate the negative impact of mastectomy and positive impact of reconstruction, and prediction accuracy will be associated with decision satisfaction and decision regret. Design, Setting, and Participants This prospective cohort survey study was conducted at a single, multidisciplinary academic oncology clinic from July 2012 to February 2014. Adult women undergoing mastectomy for stage 1, 2, or 3 invasive ductal or lobular breast cancer, ductal carcinoma in situ, or prophylaxis were invited to participate. Data analysis was conducted from September 2015 to October 2017. Exposures Mastectomy only or mastectomy with immediate reconstruction. Main Outcomes and Measures Preoperative measures predicted were 12-month happiness (Cantril Ladder) and quality of life, predicted satisfaction with breasts, sexual attractiveness, breast numbness, and pain (measured with BreastQ single items). Measures at 12 months postoperative added the Decision Regret Scale and Satisfaction With Decisions Scale. Results Of 214 eligible patients, 182 consecutive patients were approached, and 145 enrolled (80%). Of these 145 patients, 131 returned surveys (72%) and 111 of these remained at 12 months (88%). Fifteen who had delayed reconstruction were excluded from analysis, leaving a final cohort of 96 women; 54 had not had reconstruction and 42 had had reconstruction. The mean (SD) age of the cohort was 53.9 (12.1) years; 73 (76%) were white; 50 (52%) were college graduates; 54 (56%) were privately insured; 69 (72%) had disease at stages 0, 1, or 2; and 31 (32%) received adjuvant radiation. Patients having mastectomy without reconstruction underestimated future well-being in all domains. Differences were significant for quality of life scores (mean predicted, 68 vs mean actual, 74; t50, -2.47; P = .02) and satisfaction with breasts-clothed (mean predicted, 2.4 vs mean actual, 2.8; t49, -2.11; P = .04). Patients undergoing mastectomy with reconstruction overestimated future well-being in all but 1 domain. Differences were significant for satisfaction with breasts-unclothed (mean predicted, 3.1 vs mean actual, 2.6; t41, 2.70; P = .01); sexual attractiveness-clothed (mean predicted, 3.7 vs mean actual, 3.3; t39, 2.29; P = .03); sexual attractiveness-unclothed (mean predicted, 3.3 vs mean actual, 2.3; t40, 5.57; P < .001). Both groups experienced more numbness than predicted (mean predicted, 2.79 and 2.72 for mastectomy only and mastectomy with reconstruction groups, respectively; mean actual, 3.52 and 3.56, respectively; t47, -3.4 and t38, -2.9, respectively; P < .01). Patients who were less happy (β = 6.3; P = .02) or had greater pain (β = 8.7; P < .001) than predicted had greater regret. Conclusions and Relevance Patients underestimated future well-being after mastectomy and overestimated well-being after reconstruction. Misprediction was associated with regret. Decision support for breast reconstruction should address expectations about well-being.
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Affiliation(s)
- Clara Nan-Hi Lee
- Department of Plastic Surgery, College of Medicine, The Ohio State University, Columbus.,The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus
| | - Michael Patrick Pignone
- Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin.,Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center Biostatistics Core Facility, University of North Carolina, Chapel Hill
| | - Lillian Blizard
- Gastrointestinal Unit, Massachusetts General Hospital, Boston
| | - Caprice Hunt
- Department of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill
| | - Ruth Huh
- Lineberger Comprehensive Cancer Center Biostatistics Core Facility, University of North Carolina, Chapel Hill
| | - Yuen-Jong Liu
- Department of Surgery, University of North Carolina Hospitals, University of North Carolina, Chapel Hill
| | - Peter Anthony Ubel
- Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina.,School of Business, Duke University, Durham, North Carolina.,School of Public Policy and Medicine, Duke University, Durham, North Carolina
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Post-operative radiotherapy is beneficial for T1/T2 triple negative breast cancer patients with four or more positive lymph nodes. Oncotarget 2018; 8:42917-42925. [PMID: 28476034 PMCID: PMC5522115 DOI: 10.18632/oncotarget.17170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 03/27/2017] [Indexed: 12/31/2022] Open
Abstract
The efficacy of adjuvant radiotherapy for the treatment of triple negative breast cancer patients with varying numbers of positive lymph nodes is not clear. We assessed the association between adjuvant radiotherapy and survival in 943 T1/T2 triple negative breast cancer patients treated at our institute between 2008 and 2012. We determined that post-operative radiotherapy improved overall survival (OS), disease-free survival (DFS), and local recurrence-free survival (LRFS) in patients with ≥ 4 positive nodes (p = 0.037, p = 0.035, and p = 0.012, respectively). Although Cox regression analysis demonstrated that radiotherapy was a significant prognostic factor in triple negative breast cancer with ≥ 4 positive nodes, post-operative radiotherapy had no clear effect on OS, DFS, or LRFS in patients with 1-3 positive nodes (p = 0.849, p = 0.860, and p = 0.162, respectively). The prognosis (i.e., OS, DFS, and LRFS) of triple negative breast cancer patients without lymph node metastasis who underwent breast-conserving surgery and post-operative radiotherapy was similar to that of patients who underwent mastectomy alone (p = 0.336, p = 0.537, and p = 0.978, respectively). Our findings demonstrate that post-operative radiotherapy is beneficial for T1/T2 triple negative breast cancer patients with ≥ 4 positive lymph nodes.
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68
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Tan MP, Silva E. Addressing the paradox of increasing mastectomy rates in an era of de-escalation of therapy: Communication strategies. Breast 2018; 38:136-143. [DOI: 10.1016/j.breast.2017.12.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 11/13/2017] [Accepted: 12/14/2017] [Indexed: 12/18/2022] Open
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69
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Fancellu A, Sanna V, Cottu P, Feo CF, Scanu AM, Farina G, Bulla A, Spanu A, Paliogiannis P, Porcu A. Mastectomy patterns, but not rates, are changing in the treatment of early breast cancer. Experience of a single European institution on 2315 consecutive patients. Breast 2018; 39:1-7. [PMID: 29454174 DOI: 10.1016/j.breast.2018.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 01/28/2018] [Accepted: 02/08/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Recent literature reports that rates of mastectomy are increasing in early breast cancer. However, data from European institutions are limited and revealed conflicting results. We report on 15-year trends of mastectomy, mastectomy plus immediate reconstruction and contralateral prophylactic mastectomy (CPM) at an academic institution. METHODS We identified women diagnosed with unilateral early breast cancer at stage 0-IIa, with tumour size ≤ 4 cm, between 2002 and 2016. Trends were assessed using the Cochrane-Armitage test. Multivariable logistic regression was used to identify factors associated with receipt of mastectomy plus immediate reconstruction. RESULTS A total of 2315 patients were identified. Of them, 65.7% underwent breast conserving surgery (BCS), while 34.3% underwent mastectomy as upfront surgery. Two point four per cent also received CPM. Immediate reconstruction was performed in 36.0% of patients receiving mastectomy. There was no change in trends of mastectomy over the 15 years studied (p = 0.69), as well as in trends of patients undergoing CPM (p = 0.44). In contrast, rates of immediate reconstruction rose significantly over the study period (from 12.2% in 2002 to 62.7% in 2016, p < 0.0001). Women were more likely to receive mastectomy plus immediate reconstruction if they were aged 50 years or younger, or had tumours larger than 2 cm, or had non-invasive carcinoma. CONCLUSIONS Our study suggests that rates of both mastectomy and CPM in early breast cancer are not increasing, while use of immediate reconstruction is on the rise.
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Affiliation(s)
- Alessandro Fancellu
- Unit of General Surgery 2-Clinica Chirurgica, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy.
| | - Valeria Sanna
- Unit of Medical Oncology, Department of Clinical and Experimental Medicine, University Sassari, Sassari, Italy
| | - Pietrina Cottu
- Unit of General Surgery 2-Clinica Chirurgica, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Cladio F Feo
- Unit of General Surgery 2-Clinica Chirurgica, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Antonio M Scanu
- Unit of General Surgery 2-Clinica Chirurgica, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Giulia Farina
- Unit of General Surgery 2-Clinica Chirurgica, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Antonio Bulla
- Unit of Plastic Surgery, Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Sassari, Italy
| | - Angela Spanu
- Unit of Nuclear Medicine, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Panagiotis Paliogiannis
- Unit of Experimental Pathology and Oncology, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Alberto Porcu
- Unit of General Surgery 2-Clinica Chirurgica, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
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70
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Shaverdian N, Wang X, Hegde JV, Aledia C, Weidhaas JB, Steinberg ML, McCloskey SA. The patient's perspective on breast radiotherapy: Initial fears and expectations versus reality. Cancer 2018; 124:1673-1681. [PMID: 29479673 DOI: 10.1002/cncr.31159] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/09/2017] [Accepted: 10/29/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Although the efficacy and toxicity of breast radiotherapy (RT) has been studied extensively, to the authors' knowledge little is known regarding the patient's perspective on the modern breast RT experience. To better inform future patients and providers, the authors explored patient perceptions of their RT experience. METHODS Consecutive patients who were free of disease recurrence and who had been treated between 2012 and 2016 were surveyed regarding their original fears, how short-term and long-term toxicities compared with initial expectations, and how pretreatment beliefs concerning RT compared with the actual experience. RESULTS A total of 502 patients were surveyed, with a response rate of 65% (327 patients). The median patient age and posttreatment follow-up was 59 years and 31 months, respectively. Approximately 83% of patients (269 patients) underwent breast conservation therapy. Although approximately 68% of patients (221 patients) endorsed that they initially had little to no knowledge regarding RT, approximately 47% (152 patients) reported that they had heard frightening stories. Approximately 2% of patients (6 patients) agreed that the negative stories they previously heard about RT were actually true. Approximately 92% of patients treated with breast conservation (247 patients) and 81% of patients who underwent mastectomy (47 patients) agreed with the statement "If future patients knew the real truth about RT, they would be less scared about treatment." Approximately 83% (272 patients) and 84% (274 patients), respectively, of all patients reported the overall severity of short-term and long-term side effects to be better than or as expected. CONCLUSIONS Breast RT is associated with misconceptions and fears. Patients' experiences with modern breast RT appear to be superior to expectations, and the majority of patients in the current study agreed that their initial negative impressions were unfounded. Cancer 2018;124:1673-81. © 2018 American Cancer Society.
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Affiliation(s)
- Narek Shaverdian
- Department of Radiation Oncology, University of California at Los Angeles, Los Angeles, California
| | - Xiaoyan Wang
- Department of Medicine, University of California at Los Angeles, Los Angeles, California
| | - John V Hegde
- Department of Radiation Oncology, University of California at Los Angeles, Los Angeles, California
| | - Criselda Aledia
- Department of Radiation Oncology, University of California at Los Angeles, Los Angeles, California
| | - Joanne B Weidhaas
- Department of Radiation Oncology, University of California at Los Angeles, Los Angeles, California
| | - Michael L Steinberg
- Department of Radiation Oncology, University of California at Los Angeles, Los Angeles, California
| | - Susan A McCloskey
- Department of Radiation Oncology, University of California at Los Angeles, Los Angeles, California
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71
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How to optimize aesthetic outcomes in implant-based breast reconstruction. Arch Plast Surg 2018; 45:4-13. [PMID: 29316774 PMCID: PMC5784376 DOI: 10.5999/aps.2017.00528] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 06/12/2017] [Accepted: 06/22/2017] [Indexed: 01/23/2023] Open
Abstract
The evolution of breast reconstructive surgery keeps pace with the evolution of breast oncologic surgery. The reconstructive choice should always balance the optimal local control of disease and the best cosmetic result, reflecting an informed decision that is shared with the patient, who is always at the center of the decision-making process. Implant-based breast reconstruction following mastectomy represents a complex choice. In order to obtain optimal results, the following considerations are mandatory: thorough preoperative planning, a complete knowledge of the devices that are used, accurately performed surgery, and appropriate follow-up.
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72
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Gusic LH, Walsh K, Flippo-Morton T, Sarantou T, Boselli D, White RL. Rationale for Mastectomy after Neoadjuvant Chemotherapy. Am Surg 2018. [DOI: 10.1177/000313481808400133] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Neoadjuvant chemotherapy (NAC) reduces tumor size, facilitating the use of breast conservation surgery (BCS). However, mastectomy remains the surgical outcome for certain women. The goal of this study was to determine the rationale for mastectomy after NAC, particularly in women eligible for BCS. Retrospective data were reviewed on patients who received NAC between February 2006 and August 2010 at our institution. Demographics and tumor characteristics were compared between patients who received BCS and mastectomy after NAC. Of 149 patients meeting inclusion criteria, 102 (68%) underwent BCS and 47 (32%) underwent mastectomy. Patient preference was the most common rationale for mastectomy ( n = 19; 40%), followed by extent of disease ( n = 13; 28%), presence of a breast cancer susceptibility gene (BRCA) mutation ( n = 9; 19%), persistent positive margins ( n = 5; 11%), and wound complications ( n = 1; 2%). Of the 47 patients who underwent mastectomy, 37 (79%) were eligible for BCS after NAC. Larger pathologic tumor size (2.05 vs 1.25 cm, P = 0.04) and lobular histology [invasive lobular carcinomas, n = 12/17 (70%) vs invasive ductal carcinomas, n = 36/133 (27%); P < 0.01] were associated with increased rate of mastectomy. After NAC, patient preference, extent of disease, and the presence of a BRCA mutation account for the vast majority of mastectomies. Interestingly, most of these patients were shown to be candidates for breast conservation. This highlights the importance of educating patients about their surgical choice and the lack of evidence, showing a benefit to more extensive surgery.
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Affiliation(s)
| | - Kendall Walsh
- Division of Surgical Oncology, Carolinas Medical Center, Charlotte, North Carolina and
| | - Teresa Flippo-Morton
- Division of Surgical Oncology, Carolinas Medical Center, Charlotte, North Carolina and
| | - Terry Sarantou
- Division of Surgical Oncology, Carolinas Medical Center, Charlotte, North Carolina and
| | - Danielle Boselli
- Department of Cancer Biostatistics, Levine Cancer Institute, Charlotte, North Carolina
| | - Richard L. White
- Division of Surgical Oncology, Carolinas Medical Center, Charlotte, North Carolina and
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73
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Berlin NL, Hamill JB, Qi J, Kim HM, Pusic AL, Wilkins EG. Nonresponse bias in survey research: lessons from a prospective study of breast reconstruction. J Surg Res 2017; 224:112-120. [PMID: 29506826 DOI: 10.1016/j.jss.2017.11.058] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 10/05/2017] [Accepted: 11/21/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND Survey-based research is essential for evaluating the outcomes of health care in an era of patient-centered care. However, many such studies are hampered by poor response rates in completion of study questionnaires, thus limiting the generalizability of any findings. The objectives of this analysis were to identify independent variables associated with nonresponse to surveys following breast reconstruction to improve future patient-reported outcomes research. MATERIALS AND METHODS The Mastectomy Reconstruction Outcomes Consortium is a prospective cohort study involving 11 leading medical centers from the United States and Canada. Nonresponse rates for surveys assessing satisfaction with breast, satisfaction with care (BREAST-Q), depression (Patient Health Questionnaire-9), and anxiety (Generalized Anxiety Disorder-7) were measured at 1 y and 2 y postoperatively. Clinical complication rates were compared between responders and nonresponders, and multivariable models were used to assess predictors of nonresponse. RESULTS Among 2856 women in the analytic cohort, 1882 (65.9%) underwent implant-based, 817 (28.6%) received autologous, and 157 (5.5%) underwent latissimus dorsi myocutaneous flap breast reconstructions. Nonresponse rates to surveys at 1 y and 2 y were 27.8% and 34.4%, respectively. Race, ethnicity, and annual household income were associated with nonresponse to surveys. Women who underwent implant-based procedures were less likely to complete long-term surveys. CONCLUSIONS As survey-based research plays an increasingly prominent role in evaluating the outcomes of breast reconstruction, we found socioeconomic and procedure-related differences in survey response rates. Investigators must consider systematic differences in response rates among particular groups of women on the generalizability and validity of findings and perform rigorous nonresponse bias analyses.
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Affiliation(s)
- Nicholas L Berlin
- Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Jennifer B Hamill
- Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Ji Qi
- Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Hyungjin M Kim
- Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan; Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Andrea L Pusic
- Division of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Edwin G Wilkins
- Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan.
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Riedel F, Hennigs A, Hug S, Schaefgen B, Sohn C, Schuetz F, Golatta M, Heil J. Is Mastectomy Oncologically Safer than Breast-Conserving Treatment in Early Breast Cancer? Breast Care (Basel) 2017; 12:385-390. [PMID: 29456470 PMCID: PMC5803719 DOI: 10.1159/000485737] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
AIM To describe and discuss the evidence for oncological safety of different procedures in oncological breast surgery, i.e. breast-conserving treatment versus mastectomy. METHODS Literature review and discussion. RESULTS Oncological safety in breast cancer surgery has many dimensions. Breast-conserving treatment has been established as the standard surgical procedure for primary breast cancer and fits to the preferences of most breast cancer patients concerning oncological safety and aesthetic outcome. CONCLUSIONS Breast-conserving treatment is safe. Nonetheless, the preferences of the individual patients in their consideration of breast conservation versus mastectomy should be integrated into routine treatment decisions.
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Affiliation(s)
| | | | | | | | | | | | | | - Jörg Heil
- Department of Obstetrics and Gynecology, University of Heidelberg, Medical School, Heidelberg, Germany
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75
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Dayicioglu D, Tugertimur B, Zemina K, Dallarosa J, Killebrew S, Wilson A, Atisha D, Khakpour N. Vertical Mastectomy Incision in Implant Breast Reconstruction After Skin Sparing Mastectomy: Advantages and Outcomes. Ann Plast Surg 2017; 76 Suppl 4:S290-4. [PMID: 27187251 DOI: 10.1097/sap.0000000000000676] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The type of since skin-sparing mastectomy (SSM) incision directly impacts the final aesthetic and functional results of reconstruction. Different incisions are used for SSM depending on tumor location, previous biopsy scars, breast weight, and ptosis degree. A vertical scar is less visible to the patient, reminiscent of a mastopexy, and patients may not have the stigma of mastectomy. OBJECTIVE This study investigates complication rates, patient demographics, patient reported outcomes, and plastic surgeon evaluations to compare vertical incision mastectomy to other incisions. METHODS After institutional review board approval, a retrospective chart review was performed. A total population of 167 patients that underwent mastectomy with tissue expander reconstruction was separated into vertical incision and nonvertical incision mastectomy groups consisting of 38 and 129 patients, respectively. Patient demographics, complications, tumor margins, staging, breast weight, and breast implant volume were compared. BREASTQ Survey analysis was conducted using patient reported outcomes from the patient's perspective. Aesthetic evaluations of postoperative photos were systematically scored by plastic surgeons to obtain data from the plastic surgeon's perspective. RESULTS Vertical incision orientation did not increase surgical complication rates or mastectomy skin necrosis (P = 0.142). Vertical incisions did not interfere with obtaining adequate tumor margins (P = 0.907). Vertical incisions did not have a significantly different breast weight or implant volume. There was no statistical difference for patient satisfaction or plastic surgeon aesthetic evaluation. CONCLUSIONS The use of vertical incision does not increase complication rates; does not interfere with tumor margins; and can be applied to all age, BMI, breast weight, and breast implant volume groups.
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Affiliation(s)
- Deniz Dayicioglu
- From the *Department of Surgery, Division of Plastic Surgery, University of South Florida, Morsani College of Medicine, Tampa, FL; †University of South Florida, Morsani College of Medicine, Tampa, FL; and ‡Moffitt Cancer Center, Center for Women's Oncology, Tampa, FL
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76
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Dutta SW, Trifiletti DM, Grover S, Romano KD, Janowski EM, Showalter SL. The Effect of Receptor Status on Mastectomy and Contralateral Prophylactic Mastectomy Rates in Early Stage Invasive Breast Carcinoma. Clin Breast Cancer 2017; 18:121-127. [PMID: 28811185 DOI: 10.1016/j.clbc.2017.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 06/25/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is an established relationship between hormone receptor (HR; estrogen and/or progesterone receptors) status, HER2 status, and locoregional recurrence. The purpose of this study was to analyze how HR and HER2 receptor status have influenced the surgical management trends among patients with early stage breast cancer. PATIENTS AND METHODS The National Cancer Database was queried for patients with cT1 to cT3, cN0, and cM0 breast carcinoma from 2004 to 2012. Patients were grouped on the basis of receptor status and surgical management (mastectomy or breast-conserving surgery [BCS]). Multivariable analyses were performed to investigate factors associated with increased odds of receiving mastectomy over BCS. Among a subgroup of patients who underwent ipsilateral mastectomy, analyses were performed to determine any association between contralateral prophylactic mastectomy (CPM) and receptor status. RESULTS We found 280,241 patients who met inclusion criteria for analyzing mastectomy or BCS surgical decision. Patients with HER2-positive (HER2+) tumors (HR+/HER+ and HR-/HER2+) were the most likely to undergo mastectomy (odds ratio [OR], 1.212 and 1.499 respectively, compared with HR+/HER2- patients, each P < .001). HR status alone did not affect ipsilateral surgical management as patients with HR+/HER2- and HR-/HER2- tumors demonstrated similar mastectomy rates (P = .391). Among the 108,018 who underwent mastectomy, 20% underwent CPM. After adjustment, patients with HR+/HER2+, HR-/HER2+, and HR-/HER2- were all more likely to undergo CPM (OR 1.356, 1.608, and 1.358, respectively compared with HR+/HER2- patients, each P < .001). CONCLUSION This analysis indicates that patients with early stage breast cancer are more likely to undergo a mastectomy and CPM if they have HER2+ tumors.
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MESH Headings
- Adult
- Aged
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Clinical Decision-Making
- Female
- Humans
- Mastectomy, Segmental/statistics & numerical data
- Middle Aged
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/prevention & control
- Neoplasm Staging
- Patient Selection
- Prophylactic Mastectomy/statistics & numerical data
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- SEER Program/statistics & numerical data
- Young Adult
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Affiliation(s)
- Sunil W Dutta
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA.
| | - Daniel M Trifiletti
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA
| | - Surbhi Grover
- Department of Radiation Oncology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Kara D Romano
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA
| | | | - Shayna L Showalter
- Division of Surgical Oncology, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA
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Suggs PD, Holliday TL, Thompson SN, Richmond BK. Factors Affecting Choice of Treatment for Early-Stage Breast Cancer in West Virginia: A 10-Year Experience from a Rural Tertiary Care Center. Am Surg 2017. [DOI: 10.1177/000313481708300726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Recent literature shows changing trends in use of breast conservation surgery (BCS), mastectomy, and contralateral prophylactic mastectomy (CPM) in women with early-stage breast cancer (ESBC). We analyzed factors associated with selection of these treatment modalities in a rural West Virginia tertiary care hospital. We conducted a 10-year analysis of women treated for ESBC at our institution from the institutional cancer registry. Variables were compared between patients choosing BCS versus mastectomy. In women who chose mastectomy, predictors for choice of CPM were also examined. Variables with P < 0.05 on univariate analysis were entered into a multivariate logistic regression model to define independent predictors of treatment choice. The mastectomy rate increased from 18.0 per cent in 2006 to 40.2 per cent in 2013. On multivariate analysis, insurance status (P < 0.001), comorbidities (P = 0.001), and surgeon graduation after 1987—a surrogate for surgeon age—(P = 0.010) predicted receipt of mastectomy. Of those receiving mastectomy, 106 (25.1%) elected CPM. CPM rates increased from 8.0 per cent in 2006 to 45.0 per cent in 2013. Younger age at diagnosis (P < 0.001) and use of preoperative MRI (P = 0.012) independently predicted use of CPM versus unilateral mastectomy. Rates of mastectomy and CPM in ESBC have increased in West Virginia over time. Independent predictors of selecting mastectomy over BCS included insurance status, surgeon age, and associated comorbidities. Younger patients and patients receiving preoperative MRI were more likely to choose CPM. Awareness of these factors will aid in counseling women with ESBC and allow clinicians to address potential biases or disparities that may affect treatment choices. Further prospective study of these findings is warranted.
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Affiliation(s)
- Patrick D. Suggs
- West Virginia University School of Medicine, Morgantown, West Virginia
| | - Tyler L. Holliday
- West Virginia University School of Medicine, Morgantown, West Virginia
| | - Stephanie N. Thompson
- Charleston Area Medical Center Health Education and Research Institute, Charleston, West Virginia
| | - Bryan K. Richmond
- Department of Surgery, West Virginia University–Charleston Division, Charleston, West Virginia
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78
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Acellular Dermal Matrix Versus Inferior Deepithelialized Flap Breast Reconstruction: Equivalent Outcomes, with Increased Cost. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1382. [PMID: 28740788 PMCID: PMC5505849 DOI: 10.1097/gox.0000000000001382] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 04/25/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Approximately 250,000 new cases of breast cancer are diagnosed yearly in the U.S. resulting in more postmastectomy breast reconstructions (PMBRs). The acellular dermal matrix (ADM) expander-implant method became popular in the mid-2000s, but newer techniques such as the inferior deepithelialized flap (IDF) has more recently been described. We hypothesize that ADMs and IDFs provide comparable aesthetic outcomes, with no difference in complication rates and operative characteristics. METHODS A retrospective, single-institution study was performed between July 1, 2012, and June 30, 2014, examining all PMBR's (ADM and IDF). Outcomes were categorized as clinical (e.g., complications requiring surgical intervention) or aesthetic. RESULTS A total of 65 patients (41 ADM; 24 IDF; mean age, 53.4 ± 10.7 years) were included, with 101 PMBR's evaluated (63 ADM and 38 IDF). Patients who underwent IDFs had higher body mass index (32 versus 25; P < 0.01) and higher grades of breast ptosis. Major complication rates were similar between ADM and IDF groups (22% versus 31.5%; P = 0.34). There were no differences in aesthetic outcomes between groups (rater intraclass correlation, 0.92). The average IDF breast reconstruction took nearly 30 minutes longer per reconstructed side (192 minutes versus 166 minutes; P = 0.02), but operative costs were more expensive for the ADM breast reconstruction. CONCLUSIONS The IDF procedure took 30 minutes longer for each reconstructed side, without significant differences in complications or aesthetic outcomes between the 2 PMBRs. IDF reconstructions may be more suitable for patients with grade 3 breast ptosis and higher body mass index. Further studies should focus on long-term outcomes and value-based approaches to PMBR.
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79
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Grootendorst MR, Fitzgerald AJ, Brouwer de Koning SG, Santaolalla A, Portieri A, Van Hemelrijck M, Young MR, Owen J, Cariati M, Pepper M, Wallace VP, Pinder SE, Purushotham A. Use of a handheld terahertz pulsed imaging device to differentiate benign and malignant breast tissue. BIOMEDICAL OPTICS EXPRESS 2017; 8:2932-2945. [PMID: 28663917 PMCID: PMC5480440 DOI: 10.1364/boe.8.002932] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/02/2017] [Indexed: 05/19/2023]
Abstract
Since nearly 20% of breast-conserving surgeries (BCS) require re-operation, there is a clear need for developing new techniques to more accurately assess tumor resection margins intraoperatively. This study evaluates the diagnostic accuracy of a handheld terahertz pulsed imaging (TPI) system to discriminate benign from malignant breast tissue ex vivo. Forty six freshly excised breast cancer samples were scanned with a TPI handheld probe system, and histology was obtained for comparison. The image pixels on TPI were classified using (1) parameters in combination with support vector machine (SVM) and (2) Gaussian wavelet deconvolution in combination with Bayesian classification. The results were an accuracy, sensitivity, specificity of 75%, 86%, 66% for method 1, and 69%, 87%, 54% for method 2 respectively. This demonstrates the probe can discriminate invasive breast cancer from benign breast tissue with an encouraging degree of accuracy, warranting further study.
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Affiliation(s)
- Maarten R Grootendorst
- King's College London, Division of Cancer Studies, London, UK
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Contributed equally
| | - Anthony J Fitzgerald
- School of Physics, University of Western Australia, Perth, Australia
- Contributed equally
| | - Susan G Brouwer de Koning
- King's College London, Division of Cancer Studies, London, UK
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | | | | | - Matthew R Young
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Julie Owen
- King's College London, Division of Cancer Studies, King's Health Partners Cancer Biobank and Breast Pathology Research Group, London, UK
| | - Massi Cariati
- King's College London, Division of Cancer Studies, London, UK
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Michael Pepper
- Teraview Ltd., Cambridge, UK
- London Centre for Nanotechnology, University College London, UK
| | - Vincent P Wallace
- School of Physics, University of Western Australia, Perth, Australia
| | - Sarah E Pinder
- King's College London, Division of Cancer Studies, King's Health Partners Cancer Biobank and Breast Pathology Research Group, London, UK
| | - Arnie Purushotham
- King's College London, Division of Cancer Studies, London, UK
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
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80
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Disparities in Surgical Treatment of Early-Stage Breast Cancer Among Female Residents of Texas: The Role of Racial Residential Segregation. Clin Breast Cancer 2017; 17:e43-e52. [DOI: 10.1016/j.clbc.2016.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/01/2016] [Accepted: 10/12/2016] [Indexed: 12/20/2022]
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81
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Du J, Liang Q, Qi X, Ming J, Liu J, Zhong L, Fan L, Jiang J. Endoscopic nipple sparing mastectomy with immediate implant-based reconstruction versus breast conserving surgery: a long-term study. Sci Rep 2017; 7:45636. [PMID: 28361955 PMCID: PMC5374499 DOI: 10.1038/srep45636] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 03/02/2017] [Indexed: 01/04/2023] Open
Abstract
To evaluate the differences between endoscopic nipple sparing mastectomy (ENSM) with immediate implant-based reconstruction and breast conserving surgery(BCS) applied to early-stage breast cancer in postoperative outcomes, function, and cosmesis. we made a prospective, non-randomized study reviewed a total of 346 cases of breast cancer from January 2007 to December 2011, including 189 cases of BCS and 157 cases of ENSM. All the patients were followed up to April 2016, with a median follow-up time of 74 months. The operative time, blood loss and drainage, postoperative complications, postoperative cosmesis, local recurrence rate, disease-free survival rate and overall survival rate of the two groups were compared. we found out that the operative time of ENSM was longer than that of BCS. There was no difference in blood loss and drainage, the postoperative complications, the disease-free survival rate and overall survival rate between the two groups. In regarding to cosmesis, patients in the ENSM group were more likely to get a satisfactory postoperative breast appearance. we reached a conclusion that ENSM is a safe and effective operative method retainingadvantages of TSSM to further improve the postoperative cosmetic effect, without increasing other risks. The surgery provides a new choice for patients with early-stage breast cancer.
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Affiliation(s)
- Junze Du
- Breast surgery, Southwest Hospital, the Third Military Medical University, Chongqing 400038, China
| | - Quankun Liang
- Head-neck surgery, Tumor Hospital, Guangxi Medical University, Guangxi, 530021, China
| | - Xiaowei Qi
- Breast surgery, Southwest Hospital, the Third Military Medical University, Chongqing 400038, China
| | - Jia Ming
- Three glands surgery, the Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
| | - Jing Liu
- Breast surgery, Southwest Hospital, the Third Military Medical University, Chongqing 400038, China
| | - Ling Zhong
- Breast surgery, Southwest Hospital, the Third Military Medical University, Chongqing 400038, China
| | - Linjun Fan
- Breast surgery, Southwest Hospital, the Third Military Medical University, Chongqing 400038, China
| | - Jun Jiang
- Breast surgery, Southwest Hospital, the Third Military Medical University, Chongqing 400038, China
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82
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Tan QW, Luo T, Zheng H, Tian TL, He P, Chen J, Zeng HL, Lv Q. Weekly taxane-anthracycline combination regimen versus tri-weekly anthracycline-based regimen for the treatment of locally advanced breast cancer: a randomized controlled trial. CHINESE JOURNAL OF CANCER 2017; 36:27. [PMID: 28270181 PMCID: PMC5340016 DOI: 10.1186/s40880-017-0196-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 12/07/2016] [Indexed: 02/05/2023]
Abstract
Background Extensive studies have confirmed the efficacy of taxanes in combination with anthracycline-based chemotherapy on breast cancer. However, few studies have assessed the efficacy of weekly taxane–anthracycline regimens on locally advanced breast cancer. This study was to compare the efficacy and safety of a weekly taxane–anthracycline regimen with those of tri-weekly anthracycline-based regimen in patients with locally advanced breast cancer. Methods Patients with locally advanced breast cancer were randomized to receive 4–6 cycles of neoadjuvant chemotherapy with tri-weekly 5-fluorouracil–epirubicin–cyclophosphamide (FEC) regimen or weekly paclitaxel–epirubicin (PE) regimen. The primary endpoint was the pathologic complete response (pCR) rate. Other endpoints included the clinical tumor response, breast-conserving surgery rate, and adverse events. Results Between March 2010 and September 2013, 293 patients were randomized to the FEC (n = 151) and PE (n = 142) arms. The overall clinical response rate was significantly higher in the PE arm than in the FEC arm (76.06% vs. 59.95%, P = 0.001). Consistently, the post-chemotherapy pathologic T and N stages were significantly lower in the PE arm than in the FEC arm (P < 0.001). However, the pCR rate was similar in the two arms (10.61% vs. 12.31%, P = 0.665). Overall, 36 (27.27%) patients in the FEC arm and 6 (35.28%) in the PE arm were qualified for breast-conserving surgery. Most adverse events were comparable in both arms, with more severe neutropenia in the PE arm than in the FEC arm (11.97% vs. 5.96%, P = 0.031). Conclusions In patients with locally advanced breast cancer, weekly PE was not superior to FEC in terms of pCR. However, weekly PE has a higher response rate and superior down-staging effects. On this account, the PE regimen may be considered an alternative option for locally advanced breast cancer. Long-term follow-up data are needed to confirm the efficacy of this regimen on locally advanced breast cancer. Trial registration Chinese clinical trial registry, ChiCTR-TRC-10001043, September 21, 2014
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Affiliation(s)
- Qiu-Wen Tan
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, P. R. China
| | - Ting Luo
- Department of Medical Oncology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, P. R. China
| | - Hong Zheng
- Department of Medical Oncology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, P. R. China
| | - Ting-Lun Tian
- Department of Medical Oncology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, P. R. China
| | - Ping He
- Department of Medical Oncology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, P. R. China
| | - Jie Chen
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, P. R. China
| | - He-Lin Zeng
- Department of Medical Oncology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, P. R. China
| | - Qing Lv
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, P. R. China.
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Matthews H, Carroll N, Renshaw D, Turner A, Park A, Skillman J, McCarthy K, Grunfeld EA. Predictors of satisfaction and quality of life following post-mastectomy breast reconstruction. Psychooncology 2017; 26:1860-1865. [PMID: 28195672 DOI: 10.1002/pon.4397] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Breast reconstruction is associated with multiple psychological benefits. However, few studies have identified clinical and psychological factors associated with improved satisfaction and quality of life. This study examined factors, which predict satisfaction with breast appearance, outcome satisfaction and quality of life following post-mastectomy breast reconstruction. METHODS Women who underwent post-mastectomy breast reconstruction between 2010 and 2016 received a postal questionnaire consisting of The BREAST-Q Patient Reported Outcomes Instrument, The European Organisation for Research and Treatment of Cancer QLQ-30 Questionnaire, The Patient and Observer Scar Assessment Scale, and a series of Visual-Analogue Scales. One hundredforty-eight women completed the questionnaire, a 56% response rate. RESULTS Hierarchical multiple regression analyses revealed psychosocial factors accounted for 75% of the variance in breast satisfaction, 68% for outcome satisfaction, and 46% forquality of life. Psychosocial well-being emerged as a significant predictor of satisfaction with breast appearance (β = .322) and outcome satisfaction (β = .406). Deep inferior epigastric perforator flap patients reported greater satisfaction with breast appearance (β = .120) and outcome satisfaction (β = .167). CONCLUSIONS This study extends beyond the limited research by distinguishing between satisfaction with breast appearance and outcome satisfaction. The study provides evidence for the role of psychosocial factors predicting key patient reported outcomes and demonstrates the importance of psychosocial well-being and reconstruction type. The findings also highlight the need for healthcare providers to consider the psychosocial well-being of patients both preoperatively and post operatively and provide preliminary evidence for the use of deep inferior epigastric perforator reconstructions over other types of reconstructive procedures.
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Affiliation(s)
- Hannah Matthews
- Centre for Technology Enabled Health Research, Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | | | - Derek Renshaw
- Centre for Applied Biological and Exercise Sciences, Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Andrew Turner
- Centre for Technology Enabled Health Research, Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Alan Park
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Jo Skillman
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Kate McCarthy
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Elizabeth A Grunfeld
- Centre for Technology Enabled Health Research, Faculty of Health and Life Sciences, Coventry University, Coventry, UK
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Abstract
It is known that survival is unaffected by the choice of surgical management for breast cancer (BC) patients. Despite this fact, recent literature reveals that the number of bilateral mastectomies (BMs) in the United States is increasing. In an effort to elucidate potential factors influencing this trend, we investigated socioeconomic and clinicopathologic characteristics of our patient cohort that could have affected a patient's decision between unilateral mastectomy (UM) versus BM. Five-hundred-eight patients with unilateral BC who underwent mastectomy between 2000 and 2009 were analyzed: 397-UM; 111-BM. Influence of patient's age, insurance status, residence (rural versus urban), subsequent reconstruction, marital status, smoking history, family cancer history, cancer stage and grade on the BM versus UM patient's decision were analyzed using independent sample t tests, χ2 and logistic regression analysis. BM was more likely to be chosen by younger (<50 years) patients (P < 0.001); patients with private insurance [odds ratio (OR) = 2.22, 95% confidence interval (CI) = 1.4–3.5]; residence in urban settings (OR = 5.09, 95% CI = 2.5–10.4); and plans for subsequent reconstruction (OR = 2.31, 95% CI = 1.4–3.8). Marital status, smoking history, family cancer history, BC stage and grade did not significantly impact patient's choice of BM versus UM. We found that patients with unilateral BC who are younger (<50 year) have private insurance, reside in urban settings, or plan for subsequent reconstruction are more likely to undergo BM for unilateral BC. Genetic specific data were not evaluated for this patient cohort, and will be the subject of future analysis.
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85
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Freitas-Júnior R, Gagliato DM, Moura Filho JWC, Gouveia PA, Rahal RMS, Paulinelli RR, Oliveira LFP, Freitas PF, Martins E, Urban C, Lucena CÊM. Trends in breast cancer surgery at Brazil's public health system. J Surg Oncol 2017; 115:544-549. [PMID: 28168857 DOI: 10.1002/jso.24572] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 01/07/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES To analyze time trend patterns in Breast Cancer (BC) surgeries performed at Brazil's Public Health System, known as SUS from 2008 to 2014. METHODS Ecological study of time series, based on the database system from SUS. Information on surgical procedures performed for BC treatment was collected. Analysis of the absolute number of surgeries was performed using Poisson Regression through Jointpoint Regression, and the trends were calculated through the annual percentage change (APC), with a confidence interval (CI) of 95%, and statistical significance when P < 0.05. RESULTS Data analysis from 193.596 breast surgeries revealed a reduced number of simple mastectomies (APC -4.4%; CI -7.4 to -1.4; P < 0.05); stable trends in radical mastectomy with lymphadenectomy (APC -1.0%; CI -2.4 to 0.5; P = 0.1) and breast conserving surgery (APC 0.4%; CI -1.6 to 2.4; P = 0.6). Also, we observed a reduced number of axillary lymphadenectomy dissection (APC -16.8%; CI -26.8 to -5.4; P < 0.05); increased trends in breast reconstruction with implants after 2011 (APC 9.1%; CI 0.1-18.8; P < 0.05) and with flaps after 2012 (APC 61.3%; CI 41.3-84.0; P < 0.05). The overall rate of patients with breast reconstruction increased from 15% in 2008 to 29.2% in 2014. CONCLUSIONS We found a significant increase in breast reconstruction in public health system in Brazil, and also a reduction in simple mastectomy and axillary lymphadenectomy.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Edesio Martins
- Clinical Hospital of the Federal University of Goias, Goiania, Brazil
| | - Cicero Urban
- Centro de Oncologia do Paraná, Curitiba, Brazil.,Positive University, Curitiba, Brazil
| | - Clécio Ênio Murta Lucena
- Santa Casa of Belo Horizonte, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Brazil
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Smith BD, Jiang J, Shih YC, Giordano SH, Huo J, Jagsi R, Momoh AO, Caudle AS, Hunt KK, Shaitelman SF, Buchholz TA, Shirvani SM. Cost and Complications of Local Therapies for Early-Stage Breast Cancer. J Natl Cancer Inst 2017; 109:2905640. [PMID: 27678203 PMCID: PMC6075189 DOI: 10.1093/jnci/djw178] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 06/09/2016] [Accepted: 06/21/2016] [Indexed: 01/26/2023] Open
Abstract
Background Guideline-concordant local therapy options for early breast cancer include lumpectomy plus whole breast irradiation (Lump+WBI), lumpectomy plus brachytherapy, mastectomy alone, mastectomy plus reconstruction, and, in older women, lumpectomy alone. We performed a comparative examination of each treatment's complications and cost to assess their relative values. Methods Using the MarketScan database of younger women with private insurance and the SEER-Medicare database of older women with public insurance, we identified 105 211 women with early breast cancer diagnosed between 2000 and 2011. We used diagnosis and procedural codes to identify treatment complications within 24 months of diagnosis and compared complications by treatment using two-sided logistic regression. Mean total and complication-related cost, relative to Lump+WBI, were calculated from a payer's perspective and adjusted for differences in covariables using linear regression. All statistical tests were two-sided. Results Lump+WBI was the most commonly used treatment. Mastectomy plus reconstruction was associated with nearly twice the complication risk of Lump+WBI (Marketscan: 54.3% vs 29.6%, relative risk [RR] = 1.87, 95% confidence interval [CI] = 1.82 to 1.91, P < .001; SEER-Medicare: 66.1% vs 37.6%, RR = 1.75, 95% CI = 1.69 to 1.82, P < .001) and was also associated with higher adjusted total cost (Marketscan: $22 481 greater than Lump+WBI; SEER-Medicare: $1748 greater) and complication-related cost (Marketscan: $9017 greater; SEER-Medicare: $2092 greater). Brachytherapy had modestly higher total cost and complications than WBI. Lumpectomy alone entailed lower cost and complications in the SEER-Medicare cohort only. Conclusions Mastectomy plus reconstruction results in substantially higher complications and cost than other guideline-concordant treatment options for early breast cancer. These findings are relevant to patients evaluating their local therapy options and to value-based population health management.
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Affiliation(s)
- Benjamin D. Smith
- Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS)
| | - Jing Jiang
- Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS)
| | - Ya-ChenTina Shih
- Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS)
| | - Sharon H. Giordano
- Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS)
| | - Jinhai Huo
- Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS)
| | - Reshma Jagsi
- Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS)
| | - Adeyiza O. Momoh
- Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS)
| | - Abigail S. Caudle
- Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS)
| | - Kelly K. Hunt
- Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS)
| | - Simona F. Shaitelman
- Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS)
| | - Thomas A. Buchholz
- Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS)
| | - Shervin M. Shirvani
- Affiliations of authors: Department of Radiation Oncology (BDS, SFS, TAB, SMS), Department of Surgical Oncology (BDS, ASC, KKH), Department of Health Services Research (JJ, YCTS, SHG, JH), and Department of Breast Medical Oncology (SHG), University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (RJ); Center for Bioethics and Social Sciences in Medicine (RJ) and Department of Plastic Survey (AOM), University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ (SMS)
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Dominici LS, Morrow M, Mittendorf E, Bellon J, King TA. Trends and controversies in multidisciplinary care of the patient with breast cancer. Curr Probl Surg 2016; 53:559-595. [PMID: 28160790 PMCID: PMC5298793 DOI: 10.1067/j.cpsurg.2016.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Laura S Dominici
- Surgical Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Monica Morrow
- Department of Surgery, Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Jennifer Bellon
- Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Tari A King
- Surgical Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
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Chang JM, Kosiorek HE, Dueck AC, Casey WJ, Rebecca AM, Mahabir R, Patel SH, Keole SR, Wong WW, Vargas CE, Halyard MY, Gray RJ, Wasif N, Stucky CCH, Pockaj BA. Trends in mastectomy and reconstruction for breast cancer; a twelve year experience from a tertiary care center. Am J Surg 2016; 212:1201-1210. [DOI: 10.1016/j.amjsurg.2016.08.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 08/23/2016] [Accepted: 08/23/2016] [Indexed: 10/20/2022]
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89
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Huang NS, Liu MY, Chen JJ, Yang BL, Xue JY, Quan CL, Mo M, Liu GY, Shen ZZ, Shao ZM, Wu J. Surgical management of breast cancer in China: A 15-year single-center retrospective study of 18,502 patients. Medicine (Baltimore) 2016; 95:e4201. [PMID: 27828839 PMCID: PMC5106045 DOI: 10.1097/md.0000000000004201] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The aim of the study was to review the surgical trends in breast cancer treatment in China over the past 15 years and to explore the possible factors related to the choice of surgical modality.The medical records of 18,502 patients with unilateral early stage breast cancer who underwent surgery from January 1999 to December 2013 at our institute were retrospectively reviewed. The utilization of different surgical modalities and the associated clinicopathological factors were analyzed. Furthermore, the prognostic role of surgical modality was also evaluated.The median patient age was 50.0 years. According to the pTNM staging system, 12.5% of the patients were classified as stage 0; 30.2% as stage I; 40.0% as stage II; and 17.3% as stage III. In total, 9.3% of the patients could not be staged. Overall, 67.1% of the breast cancer cases were estrogen receptor (ER) positive. The pattern of breast cancer surgery has changed tremendously over the past 15 years (P < 0.001). The pattern of mastectomy has shifted from radical mastectomy to modified radical mastectomy and simple mastectomy + sentinel lymph node biopsy. A total of 81.7% of the patients underwent mastectomy without immediate reconstruction, 15.2% underwent breast-conserving surgery (BCS), and 3.7% received immediate breast reconstruction after mastectomy. Age, TNM staging, and pathological characteristics greatly affected the choice of surgical modality. The 5-year recurrence-free survival (RFS) rates for the mastectomy, BCS, and reconstruction groups were 87.6%, 93.2%, and 91.7%, respectively (P < 0.001); the RFS rate was likely affected by distant recurrence instead of loco-regional recurrence. We also identified improved RFS over time, stratified by surgical modality and tumor stage. Multivariate Cox-regression analysis revealed that time of treatment, tumor stage, tumor grade, LVI status, and ER status were independent prognostic factors for RFS in our cohort, whereas surgical modality was not.Mastectomy remains the most prevalent surgical modality used to manage early stage breast cancer in China, although the utilization of BCS has increased in the past decade. However, surgical management was not a prognostic factor for RFS. The selection of appropriate patients depended on the assessment of multiple clinicopathological factors, which is essential for making surgical decisions.
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Affiliation(s)
- Nai-si Huang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center
- Department of Oncology, Shanghai Medical College, Fudan University
| | - Meng-ying Liu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center
- Department of Oncology, Shanghai Medical College, Fudan University
| | - Jia-jian Chen
- Department of Breast Surgery, Fudan University Shanghai Cancer Center
- Department of Oncology, Shanghai Medical College, Fudan University
| | - Ben-long Yang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center
- Department of Oncology, Shanghai Medical College, Fudan University
| | - Jing-yan Xue
- Department of Breast Surgery, Fudan University Shanghai Cancer Center
- Department of Oncology, Shanghai Medical College, Fudan University
| | - Chen-lian Quan
- Department of Breast Surgery, Fudan University Shanghai Cancer Center
- Department of Oncology, Shanghai Medical College, Fudan University
| | - Miao Mo
- Department of Breast Surgery, Fudan University Shanghai Cancer Center
- Department of Clinical Statistics, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Guang-yu Liu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center
- Department of Oncology, Shanghai Medical College, Fudan University
| | - Zhen-zhou Shen
- Department of Breast Surgery, Fudan University Shanghai Cancer Center
- Department of Oncology, Shanghai Medical College, Fudan University
| | - Zhi-min Shao
- Department of Breast Surgery, Fudan University Shanghai Cancer Center
- Department of Oncology, Shanghai Medical College, Fudan University
| | - Jiong Wu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center
- Department of Oncology, Shanghai Medical College, Fudan University
- Correspondence: Jiong Wu, Fudan University Shanghai Cancer Center, Shanghai, China (e-mail: )
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90
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Tan MP, Sitoh NY, Sitoh YY. Optimising Breast Conservation Treatment for Multifocal and Multicentric Breast Cancer: A Worthwhile Endeavour? World J Surg 2016; 40:315-22. [PMID: 26560151 DOI: 10.1007/s00268-015-3336-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Breast conservation treatment (BCT) is an accepted treatment modality for early breast cancer. However, multifocal and multicentric breast cancer (MFMCBC) is a relative contraindication to BCT. This study was performed to compare BCT rates in MFMCBC and unifocal tumours and its outcomes. METHODS A retrospective analysis was performed for patients with breast malignancies who underwent operative treatment between 2009 and 2011. Successful BCT was defined as the ability to obtain clear margins for all tumour foci through a single incision with acceptable resultant cosmesis. RESULTS A total of 160 patients were analysed, of which 40 were MFMCBC. Thirty-four of the 40 patients with MFMCBC underwent BCT (85 %). After a mean follow-up period of 55 months, there were no local recurrences in patients with MFMCBC. CONCLUSION BCT was achieved in 85 % of the patients with MFMCBC in this cohort without evidence of poorer local control. Further investigation is needed to confirm this finding for its potential contribution to improved survival outcomes.
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Affiliation(s)
- Mona P Tan
- Breast Surgery, MammoCare, 38 Irrawaddy Road, #06-21, Singapore, Singapore.
| | - Nadya Y Sitoh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yih Yiow Sitoh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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91
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LeMasters T, Madhavan SS, Sambamoorthi U. Comparison of the Initial Loco-Regional Treatment Received for Early-Stage Breast Cancer between Elderly Women in Appalachia and a United States - Based Population: Good and Bad News. GLOBAL JOURNAL OF BREAST CANCER RESEARCH 2016; 4:10-19. [PMID: 27517039 DOI: 10.20941/2309-4419.2016.04.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Breast conserving surgery (BCS) followed by radiation therapy (RT) (BCS+RT) is as effective for long-term survival of invasive early-stage breast cancer (ESBC) as mastectomy, and is the local treatment option selected by the majority of women with ESBC. Women of older age and vulnerable socio-demographic characteristics are at greater risk for receiving substandard (BCS only) and non-preferred treatments (mastectomy), such as populations of women from the Appalachian region of United States. METHODS Using a retrospective cohort study design, we identified 26,106 patients from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked dataset and 811 patients from the West Virginia Cancer Registry (WVCR)-Medicare dataset age ≥ 66 diagnosed from 2003 to 2006 with stage I-II breast cancer. Multivariable logistic regression models estimated type of initial treatment received between WVCR-Medicare and SEER-Medicare patients, and the association with type of treatment. RESULTS Overall, women in WV were 0.82 (95% CI 0.68-0.99) and 0.70 (95% CI 0.58-0.84) times less likely to have mastectomy or BCS only vs. BCS+RT, than those in SEER regions. Women in WV of increasing age, greater comorbidity, stage II disease, and non-white race were more likely to have mastectomy or BCS only vs. BCS+RT, whereas, those residing in areas of higher income, higher education, and metro status were less likely, than similarly characterized women from SEER regions. CONCLUSIONS Findings from this study suggest that the magnitude of disparities in breast cancer treatment between groups of women with more and less resources are even greater in the Appalachian region, than they are among US populations. Improving access to oncology treatment services, as well as, the implementation of patient navigation programs are needed to improve patterns of initial treatment for ESBC among at-risk populations.
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Affiliation(s)
- Traci LeMasters
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, USA
| | - S Suresh Madhavan
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, USA
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Abstract
ABSTRACT
The immunocompromised host is a particularly vulnerable population in whom routine and unusual infections can easily and frequently occur. Prosthetic devices are commonly used in these patients and the infections associated with those devices present a number of challenges for both the microbiologist and the clinician. Biofilms play a major role in device-related infections, which may contribute to failed attempts to recover organisms from routine culture methods. Moreover, device-related microorganisms can be difficult to eradicate by antibiotic therapy alone. Changes in clinical practice and advances in laboratory diagnostics have provided significant improvements in the detection and accurate diagnosis of device-related infections. Disruption of the bacterial biofilm plays an essential role in recovering the causative agent in culture. Various culture and nucleic acid amplification techniques are more accurate to guide directed treatment regimens. This chapter reviews the performance characteristics of currently available diagnostic assays and summarizes published guidelines, where available, for addressing suspected infected prosthetic devices.
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93
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Rapid Discrimination of Malignant Breast Lesions from Normal Tissues Utilizing Raman Spectroscopy System: A Systematic Review and Meta-Analysis of In Vitro Studies. PLoS One 2016; 11:e0159860. [PMID: 27459193 PMCID: PMC4961451 DOI: 10.1371/journal.pone.0159860] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 07/08/2016] [Indexed: 02/05/2023] Open
Abstract
Purpose The aim of this study is to evaluate the diagnostic accuracy of Raman spectroscopy system in the detection of malignant breast lesions through a systemic review and meta-analysis of published studies. Methods We conducted a comprehensive literature search of PubMed and Embase from 2000 to June 2015. Published studies that evaluated the diagnostic performance of Raman spectroscopy in distinguishing malignant breast lesions from benign lesions and normal tissues were included in our study. The pooled sensitivity, specificity, diagnostic odds ratio, and the area under the curve of summary receiver-operating characteristic curves was derived. A Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies guidelines was used to assess the quality of included studies. Results The initial search produced a total of 157 articles after removing duplicates. Nine studies (8 in vitro and 1 in vivo) were eligible in this meta-analysis. We analyzed the eight in vitro studies with 1756 lesions, the pooled sensitivity and specificity of Raman spectroscopy system for the diagnosis of malignant breast lesions were 0.92 (95% CI 0.86–0.96) and 0.97 (97% CI 0.93–0.98), respectively. Diagnostic odds ratio was 266.70 (95% CI 89.38–795.79), and the area under the curve of summary receiver-operating characteristic curves was 0.98 (95% CI 0.97–0.99). Significant heterogeneity was found between studies. There was no evidence of considerable publication bias. Conclusions Raman spectroscopy system is an optical diagnostic technology with great value for detecting malignant breast lesions. At the same time, it has advantages of being non-invasive, real-time, and easy to use. Thus it deserves to be further explored for intra-operatory breast tumor margin detection.
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94
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Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, Stein KD, Alteri R, Jemal A. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin 2016; 66:271-89. [PMID: 27253694 DOI: 10.3322/caac.21349] [Citation(s) in RCA: 3404] [Impact Index Per Article: 425.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The number of cancer survivors continues to increase because of both advances in early detection and treatment and the aging and growth of the population. For the public health community to better serve these survivors, the American Cancer Society and the National Cancer Institute collaborate to estimate the number of current and future cancer survivors using data from the Surveillance, Epidemiology, and End Results cancer registries. In addition, current treatment patterns for the most prevalent cancer types are presented based on information in the National Cancer Data Base and treatment-related side effects are briefly described. More than 15.5 million Americans with a history of cancer were alive on January 1, 2016, and this number is projected to reach more than 20 million by January 1, 2026. The 3 most prevalent cancers are prostate (3,306,760), colon and rectum (724,690), and melanoma (614,460) among males and breast (3,560,570), uterine corpus (757,190), and colon and rectum (727,350) among females. More than one-half (56%) of survivors were diagnosed within the past 10 years, and almost one-half (47%) are aged 70 years or older. People with a history of cancer have unique medical and psychosocial needs that require proactive assessment and management by primary care providers. Although there are a growing number of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based resources are needed to optimize care. CA Cancer J Clin 2016;66:271-289. © 2016 American Cancer Society.
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Affiliation(s)
- Kimberly D Miller
- Epidemiologist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Rebecca L Siegel
- Strategic Director, Surveillance Information, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Chun Chieh Lin
- Director, Health Services Research, Intramural Research Department, American Cancer Society, Atlanta, GA
| | - Angela B Mariotto
- Branch Chief, Surveillance Research Program, National Cancer Institute, Bethesda, MD
| | - Joan L Kramer
- Assistant Professor, Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | - Julia H Rowland
- Director, Office of Cancer Survivorship, National Cancer Institute, Bethesda, MD
| | - Kevin D Stein
- Vice President, Behavioral Research Center, American Cancer Society, Atlanta, GA
| | - Rick Alteri
- Medical Editor, American Cancer Society, Atlanta, GA
| | - Ahmedin Jemal
- Vice President, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
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95
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Huang NS, Quan CL, Ma LXX, Si J, Chen JJ, Yang BL, Huang XY, Liu GY, Shen ZZ, Shao ZM, Wu J. Current status of breast reconstruction in China: an experience of 951 breast reconstructions from a single institute. Gland Surg 2016; 5:278-86. [PMID: 27294034 DOI: 10.21037/gs.2016.03.01] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Since mastectomy remained the primary strategy for treating breast cancer in China, post-mastectomy reconstruction is of great importance in the Chinese population. The current study aimed to assess the current status of breast reconstruction in China. METHODS We reviewed all patients who received breast reconstruction from August 2000 to July 2015 in the Department of Breast Surgery in our institute. Patients' baseline characteristics, reconstruction strategy, final pathology and loco-regional recurrence (LRR) information were collected. RESULTS A total of 951 breast reconstructions were conducted during the past 15 years, among which 247 (27.0%) were abdominal flap reconstruction; 471 (51.5%) were latissimus dorsi myocutaneous ± implant; and 233 (25.5%) were prosthesis-based reconstruction. The majority of cases (78.1%) were invasive breast cancer and up to 894 cases (94.0%) were immediate reconstruction. Prosthesis-based reconstruction rapidly increased in recent years, and was associated with bilateral reconstruction, contralateral augmentation and higher complications. 18 patients (2.0%) developed local-regional recurrence at the median follow-up time of 26.6 months (range, 3.7-62.0 months). A total of 66 nipple-areolar complex-sparing mastectomies (NSMs) (6.9%) were performed, none of which developed recurrence. CONCLUSIONS Breast reconstruction cases increased over the 15 years with the change of paradigm. Most strikingly, prosthesis-based reconstruction rapidly gained its prevalence and became the most common strategy. NSM was only performed for highly selected patients. Patients with breast reconstruction were able to achieve satisfactory loco-regional control in our cohort.
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Affiliation(s)
- Nai-Si Huang
- 1 Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China ; 2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China ; 3 Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Chen-Lian Quan
- 1 Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China ; 2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China ; 3 Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Lin-Xiao-Xi Ma
- 1 Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China ; 2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China ; 3 Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Jing Si
- 1 Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China ; 2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China ; 3 Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Jia-Jian Chen
- 1 Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China ; 2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China ; 3 Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Ben-Long Yang
- 1 Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China ; 2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China ; 3 Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Xiao-Yan Huang
- 1 Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China ; 2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China ; 3 Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Guang-Yu Liu
- 1 Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China ; 2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China ; 3 Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Zhen-Zhou Shen
- 1 Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China ; 2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China ; 3 Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Zhi-Min Shao
- 1 Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China ; 2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China ; 3 Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Jiong Wu
- 1 Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China ; 2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China ; 3 Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
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Turner JY, Zeniou A, Williams A, Jyothirmayi R. Technique and outcome of post-mastectomy adjuvant chest wall radiotherapy-the role of tissue-equivalent bolus in reducing risk of local recurrence. Br J Radiol 2016; 89:20160060. [PMID: 27251295 DOI: 10.1259/bjr.20160060] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: Adjuvant chest wall radiotherapy is used in patients with high-risk histological features post-mastectomy to reduce the risk of locoregional recurrence. Treatment can be given with or without a tissue-equivalent bolus to increase skin surface dose. The additional benefit of using a bolus remains unclear; however, it is known to be associated with a higher incidence of skin toxicity. This study compared chest wall recurrence and skin toxicity in patients treated with and without a bolus. METHODS: This retrospective cohort study reviewed 314 consecutive patients who received chest wall radiotherapy between 2005 and 2010. Data were collected on histological, demographic and treatment parameters and on the incidence and grade of acute skin reactions. Treatment outcomes analyzed included chest wall recurrence, disease-free survival and overall survival (OS). RESULTS: 101 patients received treatment with a bolus; 213 patients received treatment without a bolus. A significantly higher incidence of acute skin toxicity was seen in the bolus treatment group (p = 0.002). One patient treated with a bolus developed chest wall recurrence compared with four patients treated without a bolus. No statistically significant difference could be shown between the two groups. 66 (21%) patients had metastatic relapse. Median time to relapse was 29.5 months and OS was 76% in both treatment groups. CONCLUSION: No statistically significant difference in chest wall recurrence can be demonstrated between patients treated with and without a bolus. ADVANCES IN KNOWLEDGE: This study is consistent with limited previous literature and invites further evaluation of the role of a bolus in post-mastectomy chest wall radiotherapy, especially considering the increased toxicity that the use of a bolus generates.
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Affiliation(s)
| | - Anthi Zeniou
- Kent Oncology Centre, Maidstone Hospital, Maidstone, England, UK
| | - Amanda Williams
- Kent Oncology Centre, Maidstone Hospital, Maidstone, England, UK
| | - Rema Jyothirmayi
- Kent Oncology Centre, Maidstone Hospital, Maidstone, England, UK
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97
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Shiyanbola OO, Sprague BL, Hampton JM, Dittus K, James TA, Herschorn S, Gangnon RE, Weaver DL, Trentham-Dietz A. Emerging trends in surgical and adjuvant radiation therapies among women diagnosed with ductal carcinoma in situ. Cancer 2016; 122:2810-8. [PMID: 27244699 DOI: 10.1002/cncr.30105] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 03/10/2016] [Accepted: 03/14/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND The use of surgery and radiation therapy in treating ductal carcinoma in situ (DCIS) is directed by treatment guidelines and evidence from research. This study investigated recent patterns in DCIS treatment by demographic factors. METHODS Data for women diagnosed with DCIS between 1998 and 2011 (n = 416,232) in the National Cancer Data Base were assessed for trends in treatment patterns by age group, calendar year, ancestral/ethnic group, and geographic region. The likelihood of receiving specific treatment modalities was analyzed with multivariable logistic regression. RESULTS DCIS cases were most frequently treated with breast-conserving surgery (BCS) and adjuvant radiation (45.6%). After an initial rise, the use of adjuvant radiation after BCS plateaued at approximately 70% after 2007, with increasing utilization of mastectomy beyond 2005. In addition, there was an increasing trend in postmastectomy reconstruction over time, and women of African ancestry (odds ratio [OR], 0.69; 95% confidence interval [CI], 0.66-0.72) and Hispanic women (OR, 0.83; 95% CI, 0.78-0.89) were less likely to undergo reconstruction in comparison with women of European ancestry. A similar trend was observed in contralateral risk-reducing mastectomy utilization, with women of European ancestry having a more rapid rise in the utilization of contralateral risk-reducing mastectomy in comparison with all other ancestral/ethnic groups. CONCLUSIONS Recent trends demonstrate a plateau in radiation therapy administration after BCS along with increasing utilization of mastectomy, reconstruction, and contralateral risk-reducing mastectomy. There are substantial differences in treatment utilization according to ancestry/ethnicity and geographical region. Further studies examining patient-physician decision making surrounding DCIS treatment are warranted. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2810-2818. © 2016 American Cancer Society.
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Affiliation(s)
- Oyewale O Shiyanbola
- Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin
| | - Brian L Sprague
- Department of Surgery, University of Vermont, Burlington, Vermont.,University of Vermont Cancer Center, Burlington, Vermont
| | - John M Hampton
- Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin
| | - Kim Dittus
- University of Vermont Cancer Center, Burlington, Vermont.,Department of Medicine, University of Vermont, Burlington, Vermont
| | - Ted A James
- Department of Surgery, University of Vermont, Burlington, Vermont.,University of Vermont Cancer Center, Burlington, Vermont
| | - Sally Herschorn
- University of Vermont Cancer Center, Burlington, Vermont.,Department of Radiology, University of Vermont, Burlington, Vermont
| | - Ronald E Gangnon
- Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Donald L Weaver
- University of Vermont Cancer Center, Burlington, Vermont.,Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, Vermont
| | - Amy Trentham-Dietz
- Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin
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98
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Rocco N, Rispoli C, Moja L, Amato B, Iannone L, Testa S, Spano A, Catanuto G, Accurso A, Nava MB. Different types of implants for reconstructive breast surgery. Cochrane Database Syst Rev 2016; 2016:CD010895. [PMID: 27182693 PMCID: PMC7433293 DOI: 10.1002/14651858.cd010895.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Breast cancer is the most common cancer in women worldwide, and is a leading cause of cancer death among women. Prophylactic or curative mastectomy is often followed by breast reconstruction for which there are several surgical approaches that use breast implants with which surgeons can restore the natural feel, size and shape of the breast. OBJECTIVES To assess the effects of different types of breast implants on capsular contracture, surgical short- and long-term complications, postoperative satisfaction level and quality of life in women who have undergone reconstructive breast surgery after mastectomy. SEARCH METHODS We searched the Cochrane Breast Cancer Group's Specialised Register on 20 July 2015, MEDLINE (1985 to 20 July 2015), EMBASE (1985 to 20 July 2015) and the Cochrane Central Register of Controlled Trials (CENTRAL; Issue 8, 2015). We also searched the World Health Organization's International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov on 16 July 2015. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs that compared different types of breast implants for reconstructive surgery. We considered the following types of intervention: implant envelope surfaces - texturised versus smooth; implant filler material - silicone versus saline, PVP-Hydrogel versus saline; implant shape - anatomical versus round; implant volume - variable versus fixed; brands - different implant manufacturing companies and implant generation (fifth versus previous generations). DATA COLLECTION AND ANALYSIS Two review authors independently assessed methodological quality and extracted data. We used standard Cochrane methodological procedures. The quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. MAIN RESULTS Five RCTs with 202 participants met the inclusion criteria. The women participants were typically in their 50s, and the majority of them (about 82%) received reconstructive surgery following breast cancer, while the others had reconstructive surgery after prophylactic mastectomy. The studies were heterogenous in terms of implant comparisons, which prevented us from pooling the data.The studies were judged as being at an unclear risk of bias for most risk of bias items owing to poor quality of reporting in the trial publications. Three of the five RCTs were judged to be at high risk of attrition bias, and one at high risk of detection bias.Textured silicone versus smooth silicone implants: textured implants were associated with worse outcomes when compared to smooth implants (capsular contracture: risk ratio (RR) 0.82, 95% CI 0.14 to 4.71; 1 study, 20 participants; very low quality evidence; reintervention: RR 0.82, 95% CI 0.14 to 4.71; 1 study, 20 participants; very low quality evidence). No results in this comparison were statistically significant.Silicone versus saline implants: saline-filled implants performed better than silicone-filled implants for some outcomes; specifically, they produced less severe capsular contracture (RR 3.25, 95% CI 1.24 to 8.51; 1 study, 60 participants; very low quality evidence) and increased patient satisfaction (RR 0.60, 95% CI 0.41 to 0.88; 1 study, 58 participants; very low quality evidence). However reintervention was significantly more frequent in the saline-filled implant group than in the silicone-filled group (OR 0.08, 95% CI 0.01 to 0.43; 1 study, 60 participants; very low quality evidence).Poly(N-vinyl-2-pyrrolidone) hydrogel-filled (PVP-hydrogel) versus saline-filled implants: PVP-hydrogel-filled implants were associated with worse outcomes when compared to saline-filled implants (capsular contracture: RR 3.50, 95% CI 0.83 to 14.83; 1 study, 40 participants; very low quality evidence; short-term complications: RR 2.10, 95% CI 0.21 to 21.39; 1 study, 41 participants; very low quality evidence).Anatomical versus round implants: anatomical implants were associated with worse outcomes than round implants (capsular contracture: RR 2.00, 95% CI 0.20 to 20.15; 1 study, 36 participants; very low quality evidence; short-term complications: RR 2.00, 95% CI 0.42 to 9.58; 1 study, 36 participants; very low quality evidence; reintervention: RR 1.50, 95% CI 0.51 to 4.43; 1 study, 36 participants; very low quality evidence). No results in this comparison were statistically significant.Variable-volume versus fixed-volume implants: data about one-stage reconstruction using variable-volume implants were compared with data about fixed-volume implants positioned during the second surgical procedure of two-stage reconstructions. Fixed-volume implant reconstructions were possibly associated with a greater number of women reporting that their reconstruction corresponded with expected results (RR 0.25, 95% CI 0.10 to 0.62; 1 study, 40 participants; very low quality evidence) and fewer reinterventions (RR 7.00, 95% CI 1.82 to 26.89; 1 study, 40 participants; very low quality evidence) when compared to variable-volume implants. A higher patient satisfaction level (rated from 1 to 6, with 1 being very bad and 6 being very good) was found with the fixed-volume implants for overall aesthetic result (mean difference (MD) -1.10, 95% CI -1.59 to -0.61; 1 study, 40 participants; very low quality evidence).There were no studies that examined the effects of recent (fifth) generation silicone implants versus previous generations or different implant manufacturing companies. AUTHORS' CONCLUSIONS Despite the central role of breast reconstruction in women with breast cancer, the best implants to use in reconstructive surgery have been studied rarely in the context of RCTs. Furthermore the quality of these studies and the overall evidence they provide is largely unsatisfactory. Some of our results can be interpreted as early evidence of potentially large differences between different surgical approaches, which should be confirmed in new high-quality RCTs that include a larger number of women. These days - even after a few million women have had breasts reconstructed - surgeons cannot inform women about the risks and complications of different implant-based breast reconstructive options on the basis of results derived from RCTs.
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Affiliation(s)
- Nicola Rocco
- University of Naples "Federico II"Department of Clinical Medicine and SurgeryVia S. Pansini, 5NaplesItaly
| | | | - Lorenzo Moja
- University of MilanDepartment of Biomedical Sciences for HealthVia Pascal 36MilanItaly20133
- IRCCS Galeazzi Orthopaedic InstituteClinical Epidemiology UnitMilanItaly
| | - Bruno Amato
- University of Naples "Federico II"Department of Clinical Medicine and SurgeryVia S. Pansini, 5NaplesItaly
| | - Loredana Iannone
- Fatebenefratelli HospitalDepartment of General SurgeryVia Gabriele Jannelli 520NaplesItaly80131
| | - Serena Testa
- University of Naples "Federico II"Department of Anaesthesia and Intensive Care MedicineNaplesItaly
| | - Andrea Spano
- Fondazione IRCCS, Istituto Nazionale dei TumoriPlastic and Reconstructive Surgery UnitMilanItaly
| | - Giuseppe Catanuto
- Azienda Ospedaliera CannizzaroMultidisciplinary Breast UnitCataniaItaly
| | - Antonello Accurso
- University of Naples "Federico II"Department of General, Geriatric, Oncologic Surgery and Advanced TechnologiesNaplesItaly
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Tan MP. Is there an Ideal Breast Conservation Rate for the Treatment of Breast Cancer? Ann Surg Oncol 2016; 23:2825-31. [DOI: 10.1245/s10434-016-5267-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Indexed: 02/06/2023]
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Patient-reported Quality of Life and Satisfaction With Cosmetic Outcomes After Breast Conservation and Mastectomy With and Without Reconstruction: Results of a Survey of Breast Cancer Survivors. Ann Surg 2016; 261:1198-206. [PMID: 25654742 DOI: 10.1097/sla.0000000000000908] [Citation(s) in RCA: 168] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Although breast conservation is therapeutically equivalent to mastectomy for most patients with early-stage breast cancer, an increasing number of patients are pursuing mastectomy, which may be followed by breast reconstruction. We sought to evaluate long-term quality of life and cosmetic outcomes after different locoregional management approaches, as perceived by patients themselves. METHODS We surveyed women with a diagnosis of nonmetastatic breast cancer from 2005 to 2007, as reported to the Los Angeles and Detroit population-based Surveillance, Epidemiology, and End Results registries. We received responses from 2290 women approximately 9 months after diagnosis (73% response rate) and from 1536 of these 4 years later. We evaluated quality of life and patterns and correlates of satisfaction with cosmetic outcomes overall and, more specifically, within the subgroup undergoing mastectomy with reconstruction, using multivariable linear regression. RESULTS Of the 1450 patients who responded to both surveys and experienced no recurrence, 963 underwent breast-conserving surgery, 263 mastectomy without reconstruction, and 222 mastectomy with reconstruction. Cosmetic satisfaction was similar between those receiving breast conservation therapy and those receiving mastectomy with reconstruction. Among patients receiving mastectomy with reconstruction, reconstruction type and radiation receipt were associated with satisfaction (P < 0.001), with an adjusted scaled satisfaction score of 4.7 for patients receiving autologous reconstruction without radiation, 4.4 for patients receiving autologous reconstruction and radiation therapy, 4.1 for patients receiving implant reconstruction without radiation therapy, and 2.8 for patients receiving implant reconstruction and radiation therapy. CONCLUSIONS Patient-reported cosmetic satisfaction was similar after breast conservation and after mastectomy with reconstruction. In patients undergoing postmastectomy radiation, the use of autologous reconstruction may mitigate the deleterious impact of radiation on cosmetic outcomes.
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