Is there an Ideal Breast Conservation Rate for the Treatment of Breast Cancer?

Tan, Mélissa

doi:10.1245/s10434-016-5267-3

Cited by 19 publications

(9 citation statements)

References 74 publications

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“…Lastly, while mastectomy rates are decreasing, at 49%, they are still too high compared to a breast conservation goal of at least 70% [25]. Breast conservation surgery and mastectomy have equivalent survival rates (16), and with OS techniques, locoregional recurrence rates may also show no statistical difference when compared to mastectomy [26].…”

Section: Discussionmentioning

confidence: 99%

Surgical trends in breast cancer: a rise in novel operative treatment options over a 12 year analysis

Jonczyk

Jean

Graham

et al. 2018

Breast Cancer Res Treat

163

118

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Purpose Breast cancer surgical techniques are evolving. Few studies have analyzed national trends for the multitude of surgical options that include partial mastectomy (PM), mastectomy without reconstruction (M), mastectomy with reconstruction (M+R), and PM with oncoplastic reconstruction (OS). We hypothesize that the use of M is declining and likely correlates with the rise of surgery with reconstructive options (M+R, OS). Methods A retrospective cohort analysis was conducted using the ACS-NSQIP database from 2005 to 2016 and ICD codes for IBC and DCIS. Patients were then grouped together based on current procedural terminology (CPT) codes for PM, M, M+R, and OS. In each group, categories were sorted again based on additional reconstructive procedures. Data analysis was conducted via Pearson’s chi-squared test for demographics, linear regression, and a non-parametric Mann-Kendall test to assess a temporal trend. Results The patient cohort consisted of 256,398 patients from the NSQIP data base; 197,387 meet inclusion criteria diagnosed with IBC or DCIS. Annual breast surgery trends changed as follows: PM 46.3–46.1% (p = 0.21), M 35.8–26.4% (p = 0.001), M+R 15.9–23.0% (p = 0.03), and OS 1.8–4.42% (p = 0.001). Analyzing the patient cohort who underwent breast conservation, categorical analysis showed a decreased use of PM alone (96–91%) with an increased use of OS (4–9%). For the patient cohort undergoing mastectomy, M alone decreased (69–53%); M+R with muscular flap decreased (9–2%); and M+R with implant placement increased (20–40%)—all three trends p < 0.0001. Conclusion The modern era of breast surgery is identified by the increasing use of reconstruction for patients undergoing breast conservation (in the form of OS) and mastectomy (in the form of M+R). Our study provides data showing significant trends that will impact the future of both breast cancer surgery and breast training programs.

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Section: Discussionmentioning

confidence: 99%

Surgical trends in breast cancer: a rise in novel operative treatment options over a 12 year analysis

Jonczyk

Jean

Graham

et al. 2018

Breast Cancer Res Treat

163

118

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“…Tan et al. concur that a threshold of 70% best represents the evidence [ 25 ] and this corresponds with ESMO guidelines [ 28 ]. Our finding of an overall 64% of the membership achieves that BCS rate (see Fig.…”

Section: Discussionmentioning

confidence: 80%

“…Multiple prospective randomised trials over the past decades have demonstrated that patient survival after undergoing breast conserving surgery (BCS) is equivalent to mastectomy in the treatment of invasive breast cancer [ [23] , [24] , [25] ]. Internationally the breast conservation rate has been used to compare cancer care among various geographical areas and centres, race or socioeconomic status, fellowship-trained versus general surgeons etc [ 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

What are the appropriate thresholds for High Quality Performance Indicators for breast surgery in Australia and New Zealand?

2020

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Aim To evaluate BreastSurgANZ members’ compliance at various threshold rates for 4 evaluable High-Quality Performance Indicators (HQPIs) introduced to improve patient care. To benchmark global best practice to assist in determining the eventual threshold standards. Method BreastSurgANZ Quality Audit data 2012–2016 & 2018 was used to determine rates of attainment through a range of thresholds for 4 HQPI’s. Rates were assessed for different volume surgeons and comparison made to international standards. Results 1.3761 patients needing mastectomy for in situ disease, if the threshold rate for immediate breast reconstruction (IBR) was ≥ 40% then 30% of all members and 78% of very high-volume surgeons achieved that rate, which is comparable to international recommendations. 2.26,007 patients requiring mastectomy, if the threshold rate for IBR was ≥ 20% then 28% of all surgeons and 78% very high-volume surgeons met the standard. This is below most international recommendations. 3. For 31,698 invasive tumours ≤ 2 cm, if the threshold rate for breast conservation was ≥ 70% then 64% of all surgeons met the standard; 70% is comparable internationally. 4.1382 women =<50 years if the threshold rate for neoadjuvant chemotherapy was set at ≥ 15% then 36% of surgeons complied; 15% is below most international recommendations. Conclusions Even at these modest thresholds there are low levels of achievement by BreastSurgANZ members with high volume surgeons more likely to comply. These thresholds are either comparable or lower than globally accepted standards. Members should strive to meet, even exceed these important goals as they are a metric of improved patient care.

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“…10–12,26 Simultaneous oncological and reconstructive comprehensive information leads to high rates of reconstruction and presumably reduces suboptimal, from the oncological or plastic surgery standpoint, patient decisions. 8,11,12,17,27,28 However, patient's metachronous exposure to reconstructive approaches and education, providing the patient some time for reflection and extra education, results in a significant rate of at least “second thoughts” or frankly for requests of changes in the preliminary oncological plan. Possibly, education on the aesthetic outcomes, balanced information on the pitfalls of different procedures, and repeated exposure of the patient to the oncological perspective, as a geographically and timely separate encounter with another surgical consultant, all contribute to a significant rate of changes or consideration of changes.…”

Section: Discussionmentioning

confidence: 99%

The Influence of Patient Exposure to Breast Reconstruction Approaches and Education on Patient Choices in Breast Cancer Treatment

et al. 2018

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Background The landscape of surgical and medical management and patient choices for breast cancer treatment changes as breast reconstruction and oncoplastic approaches improve and diversify. Increased access to breast reconstruction, in addition to patient education, influences the breast cancer patient. Therefore, the examination of the possible impact of reconstructive surgery on all stages of the breast cancer management per se seemed timely. Methods Plastic surgery consults were arranged for 520 new patients diagnosed with breast cancer (2012–2016) including patients with noninvasive breast cancer but at high risk of further cancer development. To test the plastic surgery impact on patient choices regarding the management of the cancer, a subset of 90 patients was identified to test the plastic surgery impact on patient choices. These patients were referred to plastic surgery, following the first round of consultations by surgical and medical oncologists with only the preliminary oncological management plan defined. After a plastic surgery consultation, but prior to finalization of the overall oncological management plan, they were surveyed on the subject of modification of their personal choices and requests pertaining to their cancer management. Results In this subset of 90 patients 40 (44%) returned to their surgical or medical oncologist considering changes of the primary management plan after their plastic surgery consultation. Twenty-six (28%) ultimately altered their plan, and the following patient-driven changes were made: mastectomy as opposed to lumpectomy (18 patients [20%]), contralateral prophylactic mastectomy (11 patients [12%]), nipple/areola removal as opposed to nipple/areola sparing suggested by the oncologists (5 patients [6%]), oncoplastic breast reduction as part of lumpectomy (5 patients [6%]), and other modifications (3 patients [3%]). Conclusions Decisions for altering the preliminary oncologic plan or choosing a specific alternative (eg, lumpectomy plus radiation vs mastectomy) resulted from patient education on (1) reconstructive options, (2) aesthetic pitfalls and results. and (3) their interfacing with the oncological outcomes. Ultimately, plastic surgeons influence the multispecialty breast cancer management and patient decision-making process. Therefore, oncological literacy for plastic surgeons is essential to provide state-of-the-art breast cancer care and avoidance of suboptimal patient decisions.

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Is there an Ideal Breast Conservation Rate for the Treatment of Breast Cancer?

Cited by 19 publications

References 74 publications

Surgical trends in breast cancer: a rise in novel operative treatment options over a 12 year analysis

Surgical trends in breast cancer: a rise in novel operative treatment options over a 12 year analysis

What are the appropriate thresholds for High Quality Performance Indicators for breast surgery in Australia and New Zealand?

The Influence of Patient Exposure to Breast Reconstruction Approaches and Education on Patient Choices in Breast Cancer Treatment

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