Current practice and provision of oncoplastic breast-conserving surgery in the UK: results of the ANTHEM national practice questionnaire

Abstract

Purpose Oncoplastic breast-conserving surgery (OPBCS) may be a better option than mastectomy ± immediate breast reconstruction (IBR) for women with breast cancer but studies directly comparing the techniques are lacking. We surveyed UK breast units to determine the current practice of OPBCS to inform the design of a future comparative study. Methods An electronic survey was developed to explore the current practice of OPBCS. This included the local availability of volume displacement and/or replacement techniques; number of cases performed; contraindications and approach to contralateral symmetrisation. Summary data for each survey item were calculated and overall provision of care examined. Results 58 UK centres completed the survey, including 43 (74%) stand-alone breast and 15 (26%) combined breast/plastics units. Over 40% of units ( n = 24) treated more than 500 cancers/year. Most units offered volume displacement techniques (TMs) (97%). Over two-thirds ( n = 39. 67%) of units offered local perforator flaps (LPF). Approximately a half of units (10/19) not performing LPF were planning to introduce them in the next 12–24 months. A third ( n = 19, 33%) of units routinely performed simultaneous contralateral symmetrisation mostly with two-surgeon operating. There were limited oncological restrictions to OPBCS with no contraindications for multifocal cancers in most centres; 65% of units (36/55) offered OPBCS for multicentric disease. Extensive DCIS was a contraindication in a minority of units. Conclusions OPBCS is widely available in the UK but contraindications and approaches to contralateral symmetrisation were variable. Work is now needed to prospectively evaluate the outcomes of OPBCS vs mastectomy ± IBR to support informed decision-making. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-023-06924-0.

A clinical perspective on oncoplastic breast conserving surgery

“…In attempt to fill the gap regarding QoL, the ANTHEM study group is currently performing a prospective study on the outcomes of OPBCS to support informed decision making in the future ( 53 ).…”

Oncoplastic breast surgery in Europe

“…There is now a global shift into accepting that conservation is something to be considered even in the case of multiple ipsilateral cancers ( 17 ). Large scale studies are however required to validate these preliminary results such as the ACOSOG Z11102 (Alliance) in the USA and the ANTHEM Study in the UK, in order to disseminate these techniques routinely as a safe option for these patients ( 18 - 21 ).…”

Understanding decision-making for and against oncoplastic breast-conserving surgery as an alternative to a mastectomy in early breast cancer: UK ANTHEM qualitative study

“…Given the significant benefits of OPBCS and the widespread availability of these procedures in the UK, as demonstrated in a recent national practice survey 18 , it may be expected that, if offered OPBCS, most women would choose oncoplastic breast conservation to avoid a mastectomy. However, the Getting it Right First Time initiative suggests that less than 10% of women in the UK currently have an oncoplastic procedure, whereas mastectomy rates may be as high as 50% in some centres 5 .…”