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Evidence for reducing cancer-specific mortality due to screening for breast cancer in Europe: A systematic review. Eur J Cancer 2020; 127:191-206. [PMID: 31932175 DOI: 10.1016/j.ejca.2019.12.010] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 12/02/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND The aim of this study was to quantify the impact of organised mammography screening on breast cancer mortality across European regions. Therefore, a systematic review was performed including different types of studies from all European regions and stringently used clearly defined quality appraisal to summarise the best evidence. METHODS Six databases were searched including Embase, Medline and Web of Science from inception to March 2018. To identify all eligible studies which assessed the effect of organised screening on breast cancer mortality, two reviewers independently applied predefined inclusion and exclusion criteria. Original studies in English with a minimum follow-up of five years that were randomised controlled trials (RCTs) or observational studies were included. The Cochrane risk of bias instrument and the Newcastle-Ottawa Scale were used to assess the risk of bias. RESULTS Of the 5015 references initially retrieved, 60 were included in the final analysis. Those comprised 36 cohort studies, 17 case-control studies and 7 RCTs. None were from Eastern Europe. The quality of the included studies varied: Nineteen of these studies were of very good or good quality. Of those, the reduction in breast cancer mortality in attenders versus non-attenders ranged between 33% and 43% (Northern Europe), 43%-45% (Southern Europe) and 12%-58% (Western Europe). The estimates ranged between 4% and 31% in invited versus non-invited. CONCLUSION This systematic review provides evidence that organised screening reduces breast cancer mortality in all European regions where screening was implemented and monitored, while quantification is still lacking for Eastern Europe. The wide range of estimates indicates large differences in the evaluation designs between studies, rather than in the effectiveness of screening.
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Barco Nebreda I, Chabrera C, García-Fernández A, Giménez N, Fraile M, González S, Vallejo E, Lain JM, Vidal MC, Gonzalez C, Larrañaga I, Canales L, Pessarrodona A, García-Font M. Factors associated with the development of distant metastases in breast cancer patients-A regression model predicting organ relapse. Breast J 2019; 26:794-796. [PMID: 31524313 DOI: 10.1111/tbj.13613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Israel Barco Nebreda
- Breast Unit, University Hospital of Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - Carolina Chabrera
- Department of Nursing, School of Health Science TecnoCampus Mataró-Maresme, Barcelona, Spain
| | | | - Nuria Giménez
- Research Foundation Mútua Terrassa, University Hospital of Mútua Terrassa, University of Barcelona, Barcelona, Spain.,Laboratory of Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Fraile
- Nuclear Medicine Department, University Hospital of Mútua Terrassa, Terrassa, Spain
| | - Sonia González
- Department of Hemato-oncology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - Elena Vallejo
- Breast Unit, University Hospital of Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - Jose María Lain
- Breast Unit, Department of Gynecology, Hospital of Terrassa, Health Consortium of Terrassa, Terrassa, Spain
| | - MCarmen Vidal
- Department of Nursing, Breastfeeding Consultant, Institut Català de la Salut, Barcelona, Spain
| | - Clarisa Gonzalez
- Department of Pathology, University Hospital of Mútua Terrassa, Barcelona, Spain
| | - Itziar Larrañaga
- Breast Unit, University Hospital of Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - Lidia Canales
- Department of Radiology, University Hospital of Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - Antoni Pessarrodona
- Department of Gynecology, University Hospital of Mútua Terrassa, Barcelona, Spain
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Abstract
In the era of personalized medicine, there has been significant progress regarding the molecular analysis of breast cancer subtypes. Research efforts have focused on how classification of subtypes could provide information on prognosis and influence treatment planning. Although much is known about the impact of different molecular subtypes on disease-specific survival, more recent studies have investigated the role of the different molecular subtypes on local-regional recurrence. This is an area of active study, and in recent years there has been significant progress. This article describes outcomes among disease subtypes to aid in optimal surgical decision-making to improve local-regional control.
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Affiliation(s)
- Simona Maria Fragomeni
- Division of Gynecologic Oncology, Multidisciplinary Breast Center, Catholic University of the Sacred Heart of Rome, L.go Agostino Gemelli 8, 00168 Rome, Italy
| | - Andrew Sciallis
- Division of Anatomic Pathology, Department of Pathology, University of Michigan, Ann Arbor, MI 48105, USA
| | - Jacqueline S Jeruss
- Division of Anatomic Pathology, Department of Pathology, University of Michigan, Ann Arbor, MI 48105, USA; Division of Surgical Oncology, Department of Surgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48105, USA.
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Újhelyi M, Pukancsik D, Kelemen P, Kovács E, Kenessey I, Udvarhelyi N, Bak M, Kovács T, Mátrai Z. Does breast screening offer a survival benefit? A retrospective comparative study of oncological outcomes of screen-detected and symptomatic early stage breast cancer cases. Eur J Surg Oncol 2016; 42:1814-1820. [PMID: 27424787 DOI: 10.1016/j.ejso.2016.06.403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/19/2016] [Accepted: 06/23/2016] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Mammography screening reduces breast cancer mortality by up to 32%. However, some recent studies have questioned the impact of non-palpable breast cancer detection on mortality reduction. The aim of this study was to analyse the clinicopathological and long-term follow-up data of early stage screened and symptomatic breast cancer patients. PATIENTS AND METHOD The institutional prospectively led database was systematically analysed for breast cancer cases diagnosed via the mammography screening program from 2002 to 2009. As a control group, symptomatic early stage breast cancer patients were collected randomly from the same database and matched for age and follow-up period. All medical records were reviewed retrospectively. RESULTS Data from 298 breast cancer patients were collected from 47,718 mammography screenings. In addition, 331 symptomatic breast cancer patients were randomly selected. The screened group presented a significantly lower median tumour size (P < 0.00001). The incidence of negative regional lymph nodes was significantly higher in the screened group (P < 0.0006). The incidence of chemotherapy was 17% higher in the symptomatic group (P = 4*10-5). At the median follow-up of 65 and 80 months, the screened group did not exhibit better overall (P = 0.717) or disease-free survival (P = 0.081) compared to the symptomatic group. CONCLUSION Our results do not suggest that mammography screening does not reduce breast cancer mortality but the mammography screening did not bring any significant improvement in patient overall or disease-free survival for the early stage breast cancer patients compared to the symptomatic group. The drawback of symptomatic early stage tumours compared to non-palpable tumours could be equalized by modern multimodality oncology treatments.
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Affiliation(s)
- M Újhelyi
- National Institute of Oncology, Department of Breast and Sarcoma Surgery, Ráth György str. 7-9, 1122 Budapest, Hungary.
| | - D Pukancsik
- National Institute of Oncology, Department of Breast and Sarcoma Surgery, Ráth György str. 7-9, 1122 Budapest, Hungary
| | - P Kelemen
- National Institute of Oncology, Department of Breast and Sarcoma Surgery, Ráth György str. 7-9, 1122 Budapest, Hungary
| | - E Kovács
- National Institute of Oncology, Department of Radiological Diagnostics, Ráth György str. 7-9, 1122 Budapest, Hungary
| | - I Kenessey
- National Institute of Oncology, National Cancer Registry, Ráth György str. 7-9, 1122 Budapest, Hungary
| | - N Udvarhelyi
- National Institute of Oncology, Surgical and Molecular Tumor Pathology Centre, Ráth György str. 7-9, 1122 Budapest, Hungary
| | - M Bak
- National Institute of Oncology, Department of Cytopathology, Ráth György str. 7-9, 1122 Budapest, Hungary
| | - T Kovács
- Guy's Hospital, Breast Unit, Great Maze Pond, London SE1 9RT, United Kingdom
| | - Z Mátrai
- National Institute of Oncology, Department of Breast and Sarcoma Surgery, Ráth György str. 7-9, 1122 Budapest, Hungary
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García-Fernández A, Barco I, Fraile M, Lain JM, Carmona A, Gonzalez S, Pessarrodona A, Giménez N, García-Font M. Factors predictive of mortality in a cohort of women surgically treated for breast cancer from 1997 to 2014. Int J Gynaecol Obstet 2016; 134:212-6. [PMID: 27233816 DOI: 10.1016/j.ijgo.2016.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 02/05/2016] [Accepted: 04/27/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine whether previously reported factors predictive of breast cancer mortality are effectively linked with mortality, particularly breast-cancer-specific mortality. METHODS In a prospective study, clinical, surgical, and follow-up data were assessed for consecutive patients with breast cancer who underwent surgery between 1997 and 2014 at two centers in Barcelona, Spain. Predictors of mortality were assessed by multivariate analysis. RESULTS Overall, 2134 patients were treated for 2206 breast tumors. Overall mortality was 15.0% (n=319), and breast-cancer-specific mortality was 9.0% (n=191). On multivariate analysis, the most significant factors associated with breast-cancer-specific mortality were clinical stage, inmunohistochemical profile, locoregional relapse, and lymphovascular invasion (all P<0.001). Age at onset, participation in the mass-screening program, histologic grade, and multicentricity were not significant. Patients with three or more positive axillary nodes sustained a specific mortality significantly higher than did node-negative patients or those with fewer than three positive nodes. CONCLUSION Factors predictive of breast cancer mortality were clinical stage, locoregional relapse, molecular classification, lymphovascular invasion, and neoadjuvant chemotherapy. As a single factor, nodal disease becomes relevant only when three or more lymph nodes are involved.
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Affiliation(s)
- Antonio García-Fernández
- Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain.
| | - Israel Barco
- Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - Manel Fraile
- Nuclear Medicine Department, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - José M Lain
- Breast Unit, Department of Gynecology, Hospital of Terrassa, Health Consortium of Terrassa, Terrassa, Spain
| | - Ana Carmona
- Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - Sonia Gonzalez
- Department of Hemato-Oncology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - Antoni Pessarrodona
- Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - Nuria Giménez
- Research Unit, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain; Laboratory of Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
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Tkatch R, Hudson J, Katz A, Berry-Bobovski L, Vichich J, Eggly S, Penner LA, Albrecht TL. Barriers to cancer screening among Orthodox Jewish women. J Community Health 2016; 39:1200-8. [PMID: 24845763 DOI: 10.1007/s10900-014-9879-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The increased risk of genetic cancer mutations for Ashkenazi Jews is well known. However, little is known about the cancer-related health behaviors of a subset of Ashkenazi Jews, Orthodox Jews, who are a very religious and insular group. This study partnered with Rabbinical leadership and community members in an Orthodox Jewish community to investigate barriers to cancer screening in this community. Orthodox Jewish women were recruited to participate in focus groups designed to elicit their perspectives on barriers to cancer screening. A total of five focus groups were conducted, consisting of 3-5 members per group, stratified by age and family history of cancer. Focus groups were audio recorded and transcribed. Transcripts were coded using conventional content analysis. The resulting themes identified as barriers to cancer screening were: preservation of hidden miracles, fate, cost, competing priorities, lack of culturally relevant programming, lack of information, and fear. These results provide a unique perspective on barriers to cancer screening in a high risk but understudied population. Findings from this study may serve to inform culturally appropriate cancer education programs to overcome barriers to screening in this and other similar communities.
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Affiliation(s)
- Rifky Tkatch
- Department of Oncology, Wayne State University School of Medicine/Karmanos Cancer Institute, 4100 John R, MM03BF, Detroit, MI, 48201, USA,
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Breast Cancer Patients Undergoing Sentinel Node Biopsy: Additional Axillary Tumor Burden as a Function of the Total Number of Excised Sentinel Nodes-A Multicenter Study. Clin Breast Cancer 2015; 15:490-7. [PMID: 26044361 DOI: 10.1016/j.clbc.2015.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 03/27/2015] [Accepted: 04/16/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Recent studies have challenged the long-standing assumption that breast cancer prognosis is determined by lymph node regional status. We assessed locoregional relapse, distant metastases, and mortality alongside additional axillary disease in breast cancer patients undergoing sentinel node (SN) biopsy. PATIENTS AND METHODS This prospective study assessed 1070 women with clinical T1-T2 invasive breast cancer with negative clinical/ultrasound axillae. RESULTS A total of 25.1% of patients had positive SN biopsy findings, of whom 69.2% had only 1 involved SN. The rate of axillary recurrence was 0.7%, with no significant differences found between patients with positive or negative SN (0.6% vs. 1.1%). There were also no significant differences in the rate of distant metastases or breast cancer-specific mortality. If we had applied the Z0011 trial suggestions, residual axillary disease would have reached 16.2%: 13.5% in patients over 50% and 21.3% in patients under 50. The rate of residual axillary disease would have been 25.2% in patients with only 1 SN (20.2% in patients over 50% and 38.2% in patients under 50). In patients with 2 SN, residual disease would have ranged from 12.0% in patients over 50% to 19.0% in patients under 50. From 3 SN on, residual disease seems negligible. CONCLUSION There were no significant differences in locoregional relapse, distant metastases, or mortality between patients with negative and positive SN. Patients with 3 or more SN have no additional axillary disease. In patients younger 50, one must be extremely cautious if the Z0011 suggestions are to be applied, especially if there is only 1 SN.
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Barco I, Chabrera C, García Font M, Gimenez N, Fraile M, Lain JM, Piqueras M, Vidal MC, Torras M, González S, Pessarrodona A, Barco J, Cassadó J, García Fernández A. Comparison of Screened and Nonscreened Breast Cancer Patients in Relation to Age: A 2-Institution Study. Clin Breast Cancer 2015; 15:482-9. [PMID: 25986958 DOI: 10.1016/j.clbc.2015.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 04/02/2015] [Accepted: 04/16/2015] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Screening programs for breast cancer aim to allow early diagnosis, and thus reduce mortality. The aim of this study was to assess the effect of a population screening program in a sample of women aged between 50 and 69 years in terms of recurrence, metastasis, biological profiles, and survival, and to compare their results with those of women of a wider age range who did not participate on the screening program. PATIENTS AND METHODS A prospective multicenter study in which 1821 patients with 1873 breast tumors who received surgery between 1999 and 2014 at MútuaTerrassa University Hospital and the Hospital of Terrassa in Barcelona were analyzed. A comparison was performed in the 50- to 69-year-old age group between those who participated on the screening program and those who did not. RESULTS The mean age of patients was 58 years. The mean follow-up was 72 months, and median follow-up 59 months. The screened group showed significantly better results in all prognostic factors and in specific mortality than all nonscreened groups. The specific mortality rate in the screened patients was 2.4% (12/496), local recurrence 2.8% (14/496), and metastasis at 10 years 3.6% (18/496). In the nonscreened group, younger women presented a higher rate of metastasis (16.4% [81/493]) and a shorter disease-free period (77.1% [380/493]). The age group older than 70 years had the highest number of T4 tumors (7.5% [30/403]) and the highest proportion of radical surgery (50.4% [203/403]). CONCLUSION Patients in the screening program presented improved survival. We speculate that extending breast cancer screening programs to women younger than 50 and older than 70 years could bring about mortality benefits.
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Affiliation(s)
- Israel Barco
- Department of Gynaecology, Breast Unit, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Carol Chabrera
- Department of Nursing, School of Health Science Tecnocampus Mataró-Maresme, Barcelona, Spain
| | | | - Nuria Gimenez
- Research Unit, Research Foundation Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain; Laboratory of Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Manel Fraile
- Department of Nuclear Medicine (CTD), Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Josep María Lain
- Breast Unit, Department of Gynaecology, Hospital de Terrassa, Consorci Sanitari de Terrassa, Barcelona, Spain
| | - Merce Piqueras
- Department of Gynaecology, Breast Unit, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - M Carmen Vidal
- Department of Nursing, Breastfeeding Promotion Programme, ASSIR Mollet, Institut Català de la Salut, Barcelona, Spain
| | - Merce Torras
- Department of Nursing, Breast Unit, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Sonia González
- Department of Oncology, Breast Unit, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Antoni Pessarrodona
- Department of Gynaecology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Josep Barco
- Department of Gynaecology and Obstetrics, Clínica Sant Josep, Manresa, Spain
| | - Jordi Cassadó
- Department of Gynaecology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Antonio García Fernández
- Department of Gynaecology, Breast Unit, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain; Breast Cancer Screening Unit, Vallès Occidental, Institut Català de la Salut, Terrassa, Barcelona, Spain
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Differential patterns of recurrence and specific survival between luminal A and luminal B breast cancer according to recent changes in the 2013 St Gallen immunohistochemical classification. Clin Transl Oncol 2014; 17:238-46. [PMID: 25270605 DOI: 10.1007/s12094-014-1220-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 08/20/2014] [Indexed: 12/31/2022]
Abstract
INTRODUCTION In 2011, the St Gallen panel introduced several changes in breast cancer classification, thereby creating the luminal B Her2- subtype. In 2013, the panel also included Ki67 overexpression and PR <20 % as risk factors, while excluding GH3 in the absence of increased Ki67. We compared the classification of 2011 modified with the new 2013 St Gallen classification. PATIENTS AND METHOD Consecutive breast cancer patients referred to the Breast Unit of the University Hospital Mútua Terrassa and Hospital of Terrassa for surgical treatment of either primary or recurrent tumors were prospectively included between 1997 and 2014. Eventually, 1,874 cases were included for the four-subtype analysis. The median follow-up was of 66 months. RESULTS Using the 2013 St Gallen classification no significant differences were found in specific mortality rates between luminal A and B subtypes. There were significant differences at 5, 10, and, 15 years if we excluded luminal A GH3 patients in the absence of increased Ki67 (p = 0.004, 0.005, and 0.007). Luminal A sub-type patients showed significantly less distant metastases than the rest, including luminal B Her2- patients (p < 0.001). Also, luminal B patients showed significantly less distant metastases than pure Her2 (0.05) and triple negative (TN) (p < 0.001). There were no differences between pure Her2 and TN patients (0.055), neither among the different luminal B sub-types. CONCLUSION GH3, PR, and Ki67 may all be discriminatory factors for metastasis and specific mortality. Therefore, we suggest including GH3 in the luminal B subtype in the absence of Ki67.
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A study comparing two consecutive historical periods in breast cancer with a focus on surgical treatment, loco-regional recurrence, distant metastases and mortality. Clin Transl Oncol 2014; 17:296-305. [PMID: 25270606 DOI: 10.1007/s12094-014-1227-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 09/12/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIM Recent introduction of breast units, mass-screening programmes (SP) and sentinel node biopsy (SNB) has impacted on the clinical care of breast cancer patients (BC), resulting in a significant increase of breast-conserving surgery with the goal of achieving completely free margins and good cosmetic outcome, along with significantly less axillary morbidity. In order to ascertain the combined impact of SP and SNB on BC patients, we have reviewed the primary therapeutic approach of patients diagnosed with invasive breast carcinoma in our centre, both before and after implementation of the two new procedures. METHODS 1,942 patients operated for BC between 1997 and 2013 in two clinical centres. Two historical periods were considered: before and after the advent of the Breast Unit in our institutions and the concurrent implementation of SP and SNB (September 2002). RESULTS Rates of breast-conserving surgery and re-operations improved in the second period. Intraoperative margin re-excision increased in the second period. Breast-conserving surgery decreased in parallel to stage: from 79 % for stage I to 31 % for stage III. The Cox analysis, including stage as adjusted for all significant variables, showed statistically significant differences in favour of the initial stages but only for specific mortality, not overall mortality. CONCLUSIONS Combined implementation of breast units, SP, and SNB have resulted in a significant improvement of BC treatment leading to increased rates of breast-conserving surgery and decreased disease recurrence and mortality.
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