The Impact of Breast Clinic on the Mastectomy and Axillary Clearance Rates at a Tertiary Hospital in an Eastern Caribbean Nation: A Comparative Study

Abstract

Background. Breast cancer is the leading form of cancer in women in Trinidad and Tobago. Traditionally the practice of mastectomy or wide local excision with or without axillary clearance was applied to most of these patients. This is often associated with significant morbidity and a poor cosmetic outcome with both negatively impacting the patients quality of life. The aim of our study was to assess the mastectomy and axillary clearance rate before and after the introduction of a specialty breast clinic in September 2012. Design and Methods. This is a retrospective comparative study of all female patients who underwent breast cancer surgery at our tertiary hospital 3 years prior to and 3 years after starting of breast clinic (between January 2010 and December 2015). Patients were identified from the surgical log books of our hospital. There are 5 surgical units at our hospital and in one of those units the lead surgeon had a special interest in surgical oncoplastic breast surgery. That unit formed the breast clinic in August 2012. Results. There were 532 women (256 before breast clinic and 276 after breast clinic era) with histologically verified breast cancer operated on between January 2010 and December 2015. The overall mastectomy rate was reduced from 62% to 51% (0.7 to 0.4) and the axillary clearance rate from 66.79% versus 37.31% (0.6 to 0.4) after the introduction of the clinic with p values of 0.007 and 0.009, respectively. Conclusions. The introduction of breast clinic has significantly reduced the mastectomy and axillary clearance rate at our teaching hospital.

Breast Cancer in the Caribbean

“…Afro-Caribbean women were twice as likely to develop invasive ductal carcinoma and invasive lobular carcinoma compared to Indo-Caribbean women [ 65 , 83 , 84 ]. Consistent with global trends, subsequent studies over the years continue to realize dominant ductal carcinomas (NOS and infiltrating/invasive types) among BC cases [ 44 , 46 , 47 , 64 , 85 ]. Many BCs recorded in the national registry (n = 2,614) were aggressive; nearly 50% of cases were of regional or distant staging, with 54% being hormone receptor-negative, all of which contributed to poor survival outcomes regardless of treatment modality [ 61 ].…”

“…There are 250 new cases of BC reported on average annually with 125 deaths per year [ 44 ]. It is suggested that for every two women with BC, one may die (incidence:death ratio of 2:1) [ 45 ].…”

“…The most frequent surgical procedure was unilateral mastectomy (n = 321) which, in some cases, was combined with axillary node clearance (ANC) [ 47 ]. The introduction of a breast clinic in 2012 at a major teaching hospital in south Trinidad significantly reduced the mastectomy and ANC rate, often associated with significant morbidity and poor cosmetic outcome with both negatively impacting the quality of life of patients [ 44 ]. Breast conservation surgery (BCS) has been established as a safe option for most women with early BC, given that the five-year survival of BCS with radiation is not statistically different compared with mastectomy alone in patients with stage I or II BC [ 44 ].…”

“…The introduction of a breast clinic in 2012 at a major teaching hospital in south Trinidad significantly reduced the mastectomy and ANC rate, often associated with significant morbidity and poor cosmetic outcome with both negatively impacting the quality of life of patients [ 44 ]. Breast conservation surgery (BCS) has been established as a safe option for most women with early BC, given that the five-year survival of BCS with radiation is not statistically different compared with mastectomy alone in patients with stage I or II BC [ 44 ]. Early hospital discharge following BC surgery is now a feasible option for most BC patients and can be safely implemented in a resource-limited setting, such as Trinidad and Tobago, where cost containment and public healthcare management are essential [ 45 , 118 ].…”

Mastectomia Bilateral Com Uso De Pico™ Softport – Sistema De Terapia De Pressão Negativa De Feridas

“…Todavia, a mastectomia radical ainda mantém suas indicações frente a uma patologia mais avançada ou em pacientes portadoras de mutações deletérias dos BRCA 1/BRCA 2. Após o diagnóstico do câncer de mama, a maioria dessas mulheres entra num estado profundo de angústia devido ao medo atrelado a um desfecho estético ruim, afetando assim, negativamente, a qualidade de vida das pacientes e aumentando consideravelmente a morbidade 1 .…”