We aimed to assess retrospectively the survival outcome in patients with stage IV breast cancer who underwent surgery. In a retrospective, nonrandomized study of stage IV breast cancer patients diagnosed in a single institution between 2000 and 2012, we assessed patient's survival in the context of baseline characteristics. A total 678 patients with metastatic breast cancer were included; 412 (60.77%) underwent surgery for the primary tumor (Surgery group), and 266 (39%) did not underwent surgery for the primary tumor (Nonsurgery group), with a median follow-up of 41 months. Patients in the Surgery group had longer survival (41 versus 27 months, p < 0.0029). The 5-year survival rate for Surgery group was 34% compared with 14% for the Nonsurgery group. A multivariate analysis revealed surgery (p = 0.0003), large tumor size (p = 0.0195), ER-positive (p < 0.0001), and metastasis at presentation (p = 0.0032) were prognostic variables. Loco-regional surgery does confer a survival advantage in stage IV breast cancer, however, selection bias cannot be excluded, a well-designed and powerful randomized, controlled trial would be valuable to answer whether surgery can improve survival.

HighlightsBreast Angiosarcoma is rare and aggressive tumour that requires surgical management.Early detection, small tumor size, and clear surgical margins seem to be crucial factors for survival.Mastectomy with adequate tumor margin accompanied by close long-term follow-up is recommended.Surgery for local recurrence may be potentially curative.

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Purpose: We aimed to investigate the cost-effectiveness of mastectomy with and without different reconstruction for the purpose of determining which strategies represent value for money and identify the most cost-effective technique from the perspective of Ontario's health care system. Methods: We developed a decision analytic model to project the lifetime clinical and economic consequences of different strategies .The decision model was parameterized using 10-year follow up and cost data from Ontario administrative health databases and Ontario Cancer registry and utility data from secondary Canadian sources. Costs are presented in 2018 Canadian dollars. Future costs and benefits were discounted at 5%. Results: Compared to organized screening-based strategy, surgical strategies ranged from being more effective and cost-saving and up to being associated with an incremental cost effectiveness ratio (ICER) of $63,010 per quality-adjusted life year (QALY) gained, with BPM with immediate one-stage acellular dermal matrix (ADM)-assisted implant breast reconstruction having the greatest incremental QALY of 1.157 and lowest ICER of $9,615. Incorporating the PBM with one-stage ADM-assisted implant immediate breast reconstruction as the standard surgical strategy in Ontario would result in the largest total annual net gains of 20 QALYs and $ 1.7 million. Table 1Baseline life-time outcomes of the decision model.   Extensive breast cancer screening alone vs. surgical interventionsStrategyOverall QALYsOverall costInc. QALYInc. costICER per QALY gainedExtensive breast cancer screening18.549$90,231Ref.Ref.Ref.Prophylactic bilateral mastectomy without breast reconstruction19.057$82,011+0.508−$8,220Cost-savingProphylactic bilateral mastectomy with two-stage traditional TE-implant immediate breast reconstruction19.364$111,319+0.815+$21,088$25,868 (dominated)Prophylactic bilateral mastectomy with one-stage ADM-assisted implant immediate breast reconstruction19.706$101,359+1.157+$11,128$9,615Prophylactic bilateral mastectomy with two-stage ADM-assisted TE-implant immediate breast reconstruction19.065$122,757+0.516+$32,526$63,010 (dominated)Prophylactic bilateral mastectomy with any type of autologous immediate breast reconstruction (with or without TE or breast implant)19.501$114,014+0.951+$23,784$24,988 (dominated)Prophylactic bilateral mastectomy with one-stage non-ADM immediate breast reconstruction19.408$103,512+0.859+$13,282$15,457 (dominated)Prophylactic bilateral mastectomy with delayed breast reconstruction19.241$107,582+0.691+$17,351$25,087 (dominated)ADM;acellular dermal matrix ; TE=Tissue Expander; ICER=Incremental cost-effectiveness ratio; QALY=Quality adjusted life year Conclusion: The choice of breast reconstruction needs to be decided based on the patient body habitus, general condition and goals . BPM with and without reconstruction is likely both clinically and economically attractive. However ,all other things being equal , BPM with immediate one-stage ADM-assisted implant breast reconstruction is the most cost effective strategy and appears to offer the highest value for money. Citation Format: Aljohani BE, Hannouf MB, Grant A, Doherty C, Zaric GS, Brackstone M. Cost effectiveness of bilateral prophylactic mastectomy with and without different breast reconstruction techniques versus screening in women with high risk of breast cancer in the Canadian Province of Ontario [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD6-09.