Surgical treatment of multiple ipsilateral breast cancers

Winters, Zoë; Benson, John R.

doi:10.1002/bjs.10738

Cited by 11 publications

(11 citation statements)

References 12 publications

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“…Valuable data on 5‐year effect size for LRR could derive from a current registry study (ACOSOG (American College of Surgeons Oncology Group) Z11102)4 75. Based on this, an international collaboration guided by the IDEAL (Idea, Development, Exploration, Assessment, Long‐term Follow‐up) framework51 has suggested the need for a multicentre randomized trial (MIAMI trial)75. This trial should use a pragmatic classification of MF and MC cancers.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of the impact of breast‐conserving surgery on cancer outcomes of multiple ipsilateral breast cancers

Winters¹,

Horsnell

Elvers

et al. 2018

BJS Open

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BackgroundThe clinical effectiveness of treating ipsilateral multifocal (MF) and multicentric (MC) breast cancers using breast‐conserving surgery (BCS) compared with the standard of mastectomy is uncertain. Inconsistencies relate to definitions, incidence, staging and intertumoral heterogeneity. The primary aim of this systematic review was to compare clinical outcomes after BCS versus mastectomy for MF and MC cancers, collectively defined as multiple ipsilateral breast cancers (MIBC).MethodsComprehensive electronic searches were undertaken to identify complete papers published in English between May 1988 and July 2015, primarily comparing clinical outcomes of BCS and mastectomy for MIBC. All study designs were included, and studies were appraised critically using the Newcastle–Ottawa Scale. The characteristics and results of identified studies were summarized.ResultsTwenty‐four retrospective studies were included in the review: 17 comparative studies and seven case series. They included 3537 women with MIBC undergoing BCS; breast cancers were defined as MF in 2677 women, MC in 292, and reported as MIBC in 568. Six studies evaluated MIBC treated by BCS or mastectomy, with locoregional recurrence (LRR) rates of 2–23 per cent after BCS at median follow‐up of 59·5 (i.q.r. 56–81) months. BCS and mastectomy showed apparently equivalent rates of LRR (risk ratio 0·94, 95 per cent c.i. 0·65 to 1·36). Thirteen studies compared BCS in women with MIBC versus those with unifocal cancers, reporting LRR rates of 2–40 per cent after BCS at a median follow‐up of 64 (i.q.r. 57–73) months. One high‐quality study reported 10‐year actuarial LRR rates of 5·5 per cent for BCS in 300 women versus 6·5 per cent for mastectomy among 887 women.ConclusionThe available studies were mainly of moderate quality, historical and underpowered, with limited follow‐up and biased case selection favouring BCS rather than mastectomy for low‐risk patients. The evidence was inconclusive, weakening support for the St Gallen consensus and supporting a future randomized trial.

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Section: Discussionmentioning

confidence: 99%

Systematic review of the impact of breast‐conserving surgery on cancer outcomes of multiple ipsilateral breast cancers

Winters¹,

Horsnell

Elvers

et al. 2018

BJS Open

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“…The use of SNB in multicentric BC is still debated, however, the procedure is routinely performed in patients with clinically negative nodes in many centers, due to the evidence that its accuracy in this disease is comparable with that of published validation studies on UF tumors [41][42][43][44]. In one series, positive lymph node involvement was reported in 44-50% of MSIBC cases compared with 38% of UF cancers [45]. In a previous study conducted at our Institution, among 337 patients with multicentric BC and clinically negative axilla, having negative SNB and no axillary lymph node dissection (ALND), axillary lymph node recurrence occurred only in three patients after a median follow-up of 5 years [43].…”

Section: Preoperative Lymphoscintigraphy and The Role Of Sentinel Lymphmentioning

confidence: 99%

“…The results of trials in progress will enrich our knowledge and provide a sound scientific background for future management guidelines. The final data of ACOSOG Z11102, currently examining LRR following BCS for women with MSIBC [51] and the British MIAMI trial will evaluate the safety of oncoplastic procedures (BCS associated with mammoplasty) in MSIBC [45]. However, the limitation of this study enrolled only 50 patients.…”

Section: Breast Surgerymentioning

confidence: 99%

Multicentric breast cancer with heterogeneous histopathology: a multidisciplinary review

et al. 2020

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Multiple synchronous (multifocal or multicentric) ipsilateral breast cancers with heterogeneous histopathology are a rare clinical occurrence, however, their incidence is increasing due to the use of MRI for breast cancer screening and staging. Some studies have demonstrated poorer clinical outcomes for this pattern of breast cancer, but there is no evidence to guide clinical practice. In this multidisciplinary review, we reflect on pathology and molecular characteristics, imaging findings, surgical management including conservation and reconstructive options and approach to the axilla, and the role of chemotherapy and radiotherapy. Multidisciplinary discussions appear decisive in planning an appropriate surgical choice and defining the correct systemic treatment tailored to each clinical condition.

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“…Despite limitations of studies addressing surgical treatment of multiple ipsilateral breast cancers, rates of local recurrence are low after oncoplastic breast conserving surgery with no survival detriment. This has prompted the first randomised trial evaluating therapeutic mammaplasty versus standard mastectomy for these cases 75 .…”

Section: Breast Reconstruction and Oncoplastic Surgerymentioning

confidence: 99%

Opportunities and priorities for breast surgical research

Cutress

McIntosh

Potter

et al. 2018

The Lancet Oncology

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Background: The Breast Cancer Campaign Gap analysis (2013) established breast cancer research priorities without specific focus on surgical research nor the role of surgeons. The majority of breast cancer patients encounter a surgeon at diagnosis or during treatment, thus surgical involvement in design and delivery of high-quality research to improve patient care is critical. This review aims to identify opportunities and priorities for breast surgical research to complement the previous gap analysis. Methods: Research-active breast surgeons met and identified topic areas for breast surgical research which mapped to the patient pathway. These included diagnosis, neoadjuvant treatment, surgery, adjuvant therapy and special groups (e.g. risk-reducing surgery). Section leads were identified based on research interests with invited input from experts in specific areas, supported by consultation with the Association of Breast Surgery (ABS) membership and Independent Cancer Patients' Voice (ICPV). The document was iteratively modified until participants were satisfied that key priorities for surgical research were clear. Results: Key research gaps were identified for each topic area including: (1) issues surrounding overdiagnosis and treatment; (2) optimising selection for neoadjuvant therapies and subsequent surgery; (3) reducing re-operation rates for breast conserving surgery; (4) generating evidence for the clinical and cost-effectiveness of breast reconstruction and mechanisms for evaluating novel interventions; (5) determining optimal axillary management, especially post-neoadjuvant treatment; (6) defining and standardising indications for risk-reducing surgery. Strategies for resolving these knowledge gaps are proposed. Conclusions: Surgeons are ideally placed for a central role in breast cancer research and should foster a culture of engagement and participation in research to benefit patients and the NHS. Development of infrastructure and surgical research capacity together with appropriate allocation of research funding will be needed to successfully address the key clinical and translational research gaps highlighted in this analysis within the next two decades.

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Surgical treatment of multiple ipsilateral breast cancers

Abstract: Abundant research

Cited by 11 publications

References 12 publications

Systematic review of the impact of breast‐conserving surgery on cancer outcomes of multiple ipsilateral breast cancers

Systematic review of the impact of breast‐conserving surgery on cancer outcomes of multiple ipsilateral breast cancers

Multicentric breast cancer with heterogeneous histopathology: a multidisciplinary review

Opportunities and priorities for breast surgical research

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