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Zhu S, Li S, Huang J, Fei X, Shen K, Chen X. Time interval between breast cancer diagnosis and surgery is associated with disease outcome. Sci Rep 2023; 13:12091. [PMID: 37495705 PMCID: PMC10372101 DOI: 10.1038/s41598-023-39259-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/22/2023] [Indexed: 07/28/2023] Open
Abstract
Time interval between breast cancer (BC) diagnosis and surgery is of concern to patients and clinicians, but its impact on survival remains unclear. We identified 5130 BC patients receiving surgery between 2009 and 2017 from the Shanghai Jiaotong University Breast Cancer Database (SJTU-BCDB), and divided as Ruijin cohort and SJTU cohort. All participants were divided into three groups according to the interval between diagnosis and surgery: ≤ 1 week, 1-2 weeks, and > 2 weeks. Among 3144 patients of Ruijin cohort, the estimated 5-year breast cancer-free interval (BCFI) rates for the ≤ 1 week, 1-2 weeks and > 2 weeks groups were 91.8%, 87.5%, and 84.0% (P = 0.088), and the estimated 5-year overall survival (OS) rates were 95.6%, 89.6%, and 91.5% (P = 0.002). Multivariate analysis showed that patients with a TTS > 2 weeks had significantly lower BCFI (HR = 1.80, 95%CI 1.05-3.11, P = 0.034) and OS (HR = 2.07, 95% CI 1.04-4.13, P = 0.038) rates than patients with a TTS ≤ 1 week. Among 5130 patients when combining Ruijin cohort with SJTU cohort, the estimated 5-year BCFI rates for the ≤ 1 week, 1-2 weeks, and > 2 weeks groups were 91.0%, 87.9%, and 78.9%, and the estimated 5-year OS rates for the ≤ 1 week, 1-2 weeks, and > 2 weeks groups were 95.8%, 90.6%, and 91.5%, both with a significantly p value < 0.001. Our findings demonstrated the prolonged time to surgery (more than 2 weeks) after BC diagnosis was associated with poor disease outcomes, suggesting that efforts to early initiate treatment after diagnosis need to be pursued where possible to improve survival.
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Affiliation(s)
- Siji Zhu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Shuai Li
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Jiahui Huang
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Xiaochun Fei
- Department of Pathology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Kunwei Shen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
| | - Xiaosong Chen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
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2
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Drapalik LM, Hue JJ, Simpson A, Freyvogel M, Rock L, Shenk RR, Amin AL, Miller ME. Guideline-Consistent Treatment for Inflammatory Breast Cancer Provides Associated Survival Benefit Independent of Age. Ann Surg Oncol 2022; 29:6469-6479. [PMID: 35939169 DOI: 10.1245/s10434-022-12237-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/01/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Guideline-consistent treatment (GCT) for inflammatory breast cancer (IBC) includes neoadjuvant chemotherapy (NAC), modified radical mastectomy (MRM), and radiation. We hypothesized that younger patients more frequently receive GCT, resulting in survival differences. METHODS Using the National Cancer Database (2004-2018), female patients with unilateral IBC (by histology code and clinical stage T4d) were stratified by age (< 50, 50-65, > 65 years). Factors associated with NAC, MRM, radiation, and "GCT" (defined as all three treatments) were identified using multivariable logistic regression. Multivariable Cox proportional hazards regression identified predictors of overall survival. RESULTS Of 3278 IBC patients, 30% were younger than 50 years, 44% were 50-65 years of age, and 26% were older than 65 years. The youngest group comprised the greatest proportion of non-White patients ([35%] vs. [29%] age 50-65 years and [23%] age > 65 years, p < 0.001) and was most often treated at academic facilities ([33%] vs. [28%] age 50-65 years; and [23%] age > 65, p < 0.001). Patients older than 65 years received NAC, MRM, and radiation less frequently, and only 35% underwent GCT (vs. [57%] age 50-65 years and [52%] age < 50 years; p < 0.001). On multivariable logistic regression, age older than 65 years independently predicted omission of NAC (odds ratio [OR], 0.36), MRM (OR, 0.56), and radiation (OR, 0.56) (all p < 0.001), and patients older than 65 years also were less likely to undergo GCT than patients 50-65 years of age (OR, 0.65; p = 0.001). GCT was associated with superior overall survival in all three age groups ([hazard ratio {HR}, 0.61] age < 50 years, [HR, 0.62] age 50-65 years, [HR, 0.53] age > 65 years; all p < 0.001). CONCLUSION Advanced age alone should not limit receipt of GCT for IBC. Multimodal care should be performed for IBC patients of all ages to improve oncologic outcomes for this aggressive breast cancer subtype.
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Affiliation(s)
- Lauren M Drapalik
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Lakeside 7009, Cleveland, OH, 44106-5047, USA.,University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), Cleveland, OH, USA
| | - Jonathan J Hue
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Lakeside 7009, Cleveland, OH, 44106-5047, USA.,University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), Cleveland, OH, USA
| | - Ashley Simpson
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Lakeside 7009, Cleveland, OH, 44106-5047, USA
| | - Mary Freyvogel
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Lakeside 7009, Cleveland, OH, 44106-5047, USA
| | - Lisa Rock
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Lakeside 7009, Cleveland, OH, 44106-5047, USA
| | - Robert R Shenk
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Lakeside 7009, Cleveland, OH, 44106-5047, USA.,University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), Cleveland, OH, USA
| | - Amanda L Amin
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Lakeside 7009, Cleveland, OH, 44106-5047, USA.,University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), Cleveland, OH, USA
| | - Megan E Miller
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Lakeside 7009, Cleveland, OH, 44106-5047, USA. .,University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), Cleveland, OH, USA.
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3
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Politi J, Sala M, Domingo L, Vernet-Tomas M, Román M, Macià F, Castells X. Readmissions and complications in breast ductal carcinoma in situ: A retrospective study comparing screen- and non-screen-detected patients. ACTA ACUST UNITED AC 2020; 16:1745506520965899. [PMID: 33076785 PMCID: PMC7594253 DOI: 10.1177/1745506520965899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective: Population-wide mammographic screening programs aim to reduce breast cancer
mortality. However, a broad view of the harms and benefits of these programs
is necessary to favor informed decisions, especially in the earliest stages
of the disease. Here, we compare the outcomes of patients diagnosed with
breast ductal carcinoma in situ in participants and non-participants of a
population-based mammographic screening program. Methods: A retrospective cohort study of all patients diagnosed with breast ductal
carcinoma in situ between 2000 and 2010 within a single hospital. A total of
211 patients were included, and the median follow-up was 8.4 years. The
effect of detection mode (screen-detected and non-screen-detected) on breast
cancer recurrences, readmissions, and complications was evaluated through
multivariate logistic regression analysis. Results: In the majority of women, breast ductal carcinoma in situ was screen-detected
(63.5%). Screen-detected breast ductal carcinoma in situ was smaller in size
compared to those non-screen-detected (57.53% < 20 mm versus 78.03%,
p = 0.002). Overall, breast-conserving surgery was the most frequent surgery
(86.26%); however, mastectomy was higher in non-screen-detected breast
ductal carcinoma in situ (20.78% versus 9.7%, p = 0.024). Readmissions for
mastectomy were more frequent in non-screen-detected breast ductal carcinoma
in situ. Psychological complications, such as fatigue, anxiety, and
depression, had a prevalence of 15% within our cohort. Risk of readmissions
and complications was higher within the non-screen-detected group, as
evidenced by an odds ratio = 6.25 (95% confidence interval = 1.95–19.99) for
readmissions and an odds ratio = 2.41 (95% confidence interval = 1.95–4.86)
for complications. Conclusions: Our findings indicate that women with breast ductal carcinoma in situ breast
cancer diagnosed through population-based breast cancer screening program
experience a lower risk of readmissions and complications than those
diagnosed outside these programs. These findings can help aid women and
health professionals make informed decisions regarding screening.
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Affiliation(s)
- Julieta Politi
- Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Preventive Medicine and Public Health Training Unit, Parc de Salut Mar-Pompeu Fabra University-Agència de Salut Pública de Barcelona (PSMar-UPF-ASPB), Barcelona, Spain
| | - María Sala
- Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laia Domingo
- Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - María Vernet-Tomas
- Breast Surgery, Obstetrics and Gynaecology Department, Hospital del Mar, Barcelona, Spain
| | - Marta Román
- Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Francesc Macià
- Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
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4
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Lamb LR, Mercaldo S, Oseni TO, Bahl M. Predictors of Reexcision following Breast-Conserving Surgery for Ductal Carcinoma In Situ. Ann Surg Oncol 2020; 28:1390-1397. [PMID: 32914389 DOI: 10.1245/s10434-020-09101-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/15/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Reexcision following breast-conserving surgery (BCS) in women with ductal carcinoma in situ (DCIS) results in adjuvant treatment delays, higher health care costs, and undesirable cosmetic outcomes. The purpose of this study is to determine patient, imaging, pathological, and surgical predictors of reexcision following BCS for DCIS. PATIENTS AND METHODS A retrospective review of women with DCIS who had BCS from 2007 to 2016 was conducted. Patient, imaging, pathological, and surgical features, in addition to surgical outcomes, were collected from medical records. Standard statistical tests were used to compare features between patients who did and did not undergo at least one reexcision. A multivariable logistic regression model was fit to assess features associated with reexcision. RESULTS A total of 547 women (mean age 59 years; range 30-88 years) diagnosed with DCIS at core needle biopsy underwent BCS. Of all women, 31.6% (173/547) had at least one reexcision. With multivariable analysis, features associated with reexcision included younger patient age (adjusted odds ratio [aOR] 0.98, 95% confidence interval [CI] 0.97-1.0, p = 0.049), African-American race (aOR 2.66, 95% CI 1.13-6.26, p = 0.03), biopsy modality of ultrasound (aOR 2.35, 95% CI 1.22-4.53, p = 0.01), and earlier year of surgery (aOR 0.92, 95% CI 0.86-0.98, p = 0.01). No pathological features of DCIS were associated with reexcision risk. CONCLUSIONS In our cohort of nearly 550 women with DCIS who underwent BCS, 31.6% had at least one reexcision. Features associated with reexcision include younger patient age, African-American race, biopsy modality of ultrasound, and earlier year of surgery.
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Affiliation(s)
- Leslie R Lamb
- Division of Breast Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Sarah Mercaldo
- Division of Breast Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Tawakalitu O Oseni
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Manisha Bahl
- Division of Breast Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
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5
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Time-to-surgery and overall survival after breast cancer diagnosis in a universal health system. Breast Cancer Res Treat 2019; 178:441-450. [DOI: 10.1007/s10549-019-05404-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 08/08/2019] [Indexed: 12/18/2022]
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McCrate F, Dicks E, Powell E, Chafe J, Roome R, Simmonds C, Etchegary H. Surgical treatment choices for breast cancer in Newfoundland and Labrador: a retrospective cohort study. Can J Surg 2019; 61:377-384. [PMID: 30265635 DOI: 10.1503/cjs.015217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Mastectomy is often chosen by women for treatment of breast cancer, even when breast-conserving surgery (BCS) is an option. Newfoundland and Labrador has a high mastectomy rate. We documented the number of breast cancers over a given period in the province and their related surgical treatments, and explored the impact of several variables on surgical choice. METHODS A retrospective cohort design linked diagnosis data from the Newfoundland and Labrador tumour registry to surgery data from the Canadian Institute for Health Information Discharge Abstract Database. Data were extracted for all women aged 19 years or more in whom breast cancer was diagnosed in 2009-2014. RESULTS A total of 2346 cases of breast cancer with a linked surgical procedure were included. Most operations (1605 [68.4%]) were mastectomy procedures, with the remainder being BCS. Logistic regression analysis revealed that women were 1.82 times (95% confidence interval [CI] 1.64-2.02) more likely to have mastectomy for each unit of stage increase from 0 to IV and 1.15 times (95% CI 1.11-1.21) more likely for each unit of driving time increase. CONCLUSION Tumour stage and driving time to a radiation facility significantly predicted Newfoundland and Labrador women's surgical treatment choices for breast cancer. Notably, mastectomy was the favoured choice across all age groups, tumour stages and geographical regions of the province. We hope that these results will galvanize efforts to better understand local surgical practices and assist in improving the quality of surgical care of women with breast cancer.
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Affiliation(s)
- Farah McCrate
- From the Cancer Care Program, Eastern Regional Health Authority, St. John's, Nfld. (McCrate, Powell); the Faculty of Medicine, Memorial University, St. John's, Nfld. (Dicks, Etchegary)); the Centre for Nursing Studies, Eastern Regional Health Authority, St. John's, Nfld. (Chafe); patient/community representative, St. John's, Nfld. (Roome); and the Health Research Unit, Faculty of Medicine, St. John's, Nfld. (Simmonds)
| | - Elizabeth Dicks
- From the Cancer Care Program, Eastern Regional Health Authority, St. John's, Nfld. (McCrate, Powell); the Faculty of Medicine, Memorial University, St. John's, Nfld. (Dicks, Etchegary)); the Centre for Nursing Studies, Eastern Regional Health Authority, St. John's, Nfld. (Chafe); patient/community representative, St. John's, Nfld. (Roome); and the Health Research Unit, Faculty of Medicine, St. John's, Nfld. (Simmonds)
| | - Erin Powell
- From the Cancer Care Program, Eastern Regional Health Authority, St. John's, Nfld. (McCrate, Powell); the Faculty of Medicine, Memorial University, St. John's, Nfld. (Dicks, Etchegary)); the Centre for Nursing Studies, Eastern Regional Health Authority, St. John's, Nfld. (Chafe); patient/community representative, St. John's, Nfld. (Roome); and the Health Research Unit, Faculty of Medicine, St. John's, Nfld. (Simmonds)
| | - Joanne Chafe
- From the Cancer Care Program, Eastern Regional Health Authority, St. John's, Nfld. (McCrate, Powell); the Faculty of Medicine, Memorial University, St. John's, Nfld. (Dicks, Etchegary)); the Centre for Nursing Studies, Eastern Regional Health Authority, St. John's, Nfld. (Chafe); patient/community representative, St. John's, Nfld. (Roome); and the Health Research Unit, Faculty of Medicine, St. John's, Nfld. (Simmonds)
| | - Rebecca Roome
- From the Cancer Care Program, Eastern Regional Health Authority, St. John's, Nfld. (McCrate, Powell); the Faculty of Medicine, Memorial University, St. John's, Nfld. (Dicks, Etchegary)); the Centre for Nursing Studies, Eastern Regional Health Authority, St. John's, Nfld. (Chafe); patient/community representative, St. John's, Nfld. (Roome); and the Health Research Unit, Faculty of Medicine, St. John's, Nfld. (Simmonds)
| | - Charlene Simmonds
- From the Cancer Care Program, Eastern Regional Health Authority, St. John's, Nfld. (McCrate, Powell); the Faculty of Medicine, Memorial University, St. John's, Nfld. (Dicks, Etchegary)); the Centre for Nursing Studies, Eastern Regional Health Authority, St. John's, Nfld. (Chafe); patient/community representative, St. John's, Nfld. (Roome); and the Health Research Unit, Faculty of Medicine, St. John's, Nfld. (Simmonds)
| | - Holly Etchegary
- From the Cancer Care Program, Eastern Regional Health Authority, St. John's, Nfld. (McCrate, Powell); the Faculty of Medicine, Memorial University, St. John's, Nfld. (Dicks, Etchegary)); the Centre for Nursing Studies, Eastern Regional Health Authority, St. John's, Nfld. (Chafe); patient/community representative, St. John's, Nfld. (Roome); and the Health Research Unit, Faculty of Medicine, St. John's, Nfld. (Simmonds)
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7
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van Leeuwen MT, Falster MO, Vajdic CM, Crowe PJ, Lujic S, Klaes E, Jorm L, Sedrakyan A. Reoperation after breast-conserving surgery for cancer in Australia: statewide cohort study of linked hospital data. BMJ Open 2018; 8:e020858. [PMID: 29643165 PMCID: PMC5898348 DOI: 10.1136/bmjopen-2017-020858] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To investigate between-hospital variation in the probability of reoperation within 90 days of initial breast-conserving surgery (BCS), and the contribution of health system-level and other factors. DESIGN Population-based, retrospective cohort study. SETTING New South Wales (NSW), Australia. PARTICIPANTS Linked administrative hospitalisation data were used to define a cohort of adult women undergoing initial BCS for breast cancer in NSW between 1 July 2002 and 31 December 2013. PRIMARY OUTCOME MEASURES Multilevel, cross-classified models with patients clustered within hospitals and residential areas were used to examine factors associated with any reoperation, and either re-excision or mastectomy, within 90 days. RESULTS Of 34 458 women undergoing BCS, 29.1% underwent reoperation within 90 days, half of which were mastectomies. Overall, the probability of reoperation decreased slightly over time. However, there were divergent patterns by reoperation type; the probability of re-excision increased alongside a concomitant decrease in the probability of mastectomy. Significant between-hospital variation was observed. Non-metropolitan location and surgery at low-volume hospitals were associated with a higher overall probability of reoperation, and of mastectomy specifically, after accounting for patient-level factors, calendar year and area-level socioeconomic status. The magnitude of association with geographical location and surgical volume decreased over time. CONCLUSIONS Reoperation rates within 90 days of BCS varied significantly between hospitals. For women undergoing mastectomy after BCS, this represents a dramatic change in clinical course. Multilevel modelling suggests unwarranted clinical variation may be an issue, likely due to disparities in access to multidisciplinary breast cancer care and preoperative diagnostic procedures. However, the observed reduction in disparities over time is encouraging and indicates that guidelines and policy initiatives have the potential to improve regional breast cancer care.
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Affiliation(s)
- Marina T van Leeuwen
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael O Falster
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Claire M Vajdic
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Philip J Crowe
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Sanja Lujic
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Elizabeth Klaes
- Breast Cancer Network Australia, Camberwell, Victoria, Australia
| | - Louisa Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Art Sedrakyan
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York City, New York, USA
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8
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Ageism and surgical treatment of breast cancer in Italian hospitals. Aging Clin Exp Res 2018; 30:139-144. [PMID: 28391587 DOI: 10.1007/s40520-017-0757-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 04/04/2017] [Indexed: 01/24/2023]
Abstract
AIM To determine if age is a factor influencing the type of breast cancer surgery (radical versus conservative) in Italy and to investigate the regional differences in breast cancer surgery clinical practice. METHODS Retrospective study is based on national hospital discharge records. The study draws on routinely collected data from hospital discharge records in Italy in 2010. The following exclusion criteria were applied: day hospital stays, patients younger than 17 years, males, patients without an ICD-9CM code indicating breast cancer and breast surgery, and repeated hospital admission of the same patient. Overall, 49,058 patient records were selected for the analysis. RESULTS The proportion of conservative breast cancer operations was 70.9%. A greater number of women younger than 70 had undergone a breast-conserving operation compared to older women. There were regional variations ranging from a minimum in Basilicata to a maximum in Val d'Aosta. Multivariate analysis revealed that older patients with lower clinical severity were more likely to have undergone a radical operation than younger women. In addition, radical surgery was approximately twice as likely to occur in a private hospital that performed at least 50 breast cancer operations annually than in a public hospital that performed <50 breast surgeries. CONCLUSION Notwithstanding increases in life expectancy and the lack of clinical evidence to support the use of age as a surrogate for co-morbid conditions and frailty, our data on breast cancer operations in Italy are consistent with the hypothesis suggesting the persistence of ageistic practice in the healthcare system.
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Abstract
BACKGROUND Although breast reconstruction has been shown to improve psychological, physical, and sexual well-being, Australia still has one of the lowest reconstruction rates among well-developed countries. This study explores both the quality-of-life benefits of reconstruction and the factors that influence patients' decisions of whether or not to undergo reconstruction. METHODS This retrospective cohort study (296 consecutive mastectomy patients from 2000 to 2010) uses an internationally validated questionnaire (BREAST-Q) to evaluate patients' satisfaction with or without breast reconstruction. In addition, we analyzed factors that influence patients' decisions of whether to undergo reconstruction. RESULTS Two hundred nineteen patients responded (74%) and of the 143 patients who elected to participate, 79 were in the "reconstruction group" and 64 in the "no-reconstruction group" post mastectomy. Patient demographics and cancer variables of the 2 groups were matched with the exception of age (reconstruction group 9.7 years younger: P < 0.01). The reconstruction group showed statistically significantly higher BREAST-Q scores with regard to satisfaction with the breast (P < 0.0001), psychological well-being (P = 0.0068), and sexual well-being (P = 0.0001). For the reconstruction group, the main reasons for undergoing reconstruction included improved self-image, more clothing choices, and the feeling of overcoming the cancer. One third of non-reconstructed patients still feared that reconstruction would mask cancer recurrence. CONCLUSION Our study confirms the positive effects of breast reconstruction post mastectomy and identifies reasons that influence patients' decisions of whether to undergo reconstruction. Breast reconstruction should be seen as an integral part in the comprehensive care of women with breast cancer and an important health care priority in Australia.
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Lodi M, Scheer L, Reix N, Heitz D, Carin AJ, Thiébaut N, Neuberger K, Tomasetto C, Mathelin C. Breast cancer in elderly women and altered clinico-pathological characteristics: a systematic review. Breast Cancer Res Treat 2017; 166:657-668. [PMID: 28803352 DOI: 10.1007/s10549-017-4448-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 08/07/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE Breast cancer is the most common malignancy in women in terms of incidence and mortality. Age is undoubtedly the biggest breast cancer risk factor. In this study we examined clinical, histological, and biological characteristics and mortality of breast cancer in elderly women along with their changes with advancing age. METHODS We reviewed 63 original articles published between 2006 and 2016 concerning women over 70 years with breast cancer. RESULTS Compared to patients 70-79 years, patients aged 80 and over had larger tumor size with fewer T1 (42.9% vs 57.7%, p < 0.01) and more T2 lesions (43.5% vs 33.0%, p < 0.01). Lymph nodes and distant metastases were more frequent, with more N + (49.5% vs 44.0%, p < 0.01) and more M1 (8.0% vs 5.9%, p < 0.01). Infiltrating mucinous carcinomas were more frequent (4.3% vs 3.7%, p < 0.01). Tumors had lower grades, with more grade 1 (23.2% vs 19.8%, p = 0.01) and fewer grade 3 (21.5% vs 25.5%, p < 0.01), and were more hormone-sensitive: PR was more often expressed (72.6% vs 67.3%, p < 0.01). Lympho-vascular invasion was less frequent in the 80 years and over (22.9% vs 29.7%, p = 0.01). Breast cancer-specific mortality was higher both at 5 years (25.8% vs 17.2%, p < 0.01) and 10 years (32.7% vs 26.6%, p < 0.01). CONCLUSION Clinico-pathological characteristics, increased incidence, and mortality associated with aging can be explained on one hand by biological changes of the breast such as increased estrogen sensitivity, epithelial cell alterations, immune senescence, and tumor microenvironment modifications. However, sociologic factors such as increased life expectancy, under-treatment, late diagnosis, and insufficient individual screening, are also involved.
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Affiliation(s)
- M Lodi
- Senology Unit, Strasbourg University Hospital, Hôpital de Hautepierre 1, Avenue Molière, 67200, Strasbourg, France.
| | - L Scheer
- Senology Unit, Strasbourg University Hospital, Hôpital de Hautepierre 1, Avenue Molière, 67200, Strasbourg, France
| | - N Reix
- ICube, UMR 7357, Strasbourg University/CNRS, Fédération de Médecine Translationnelle de Strasbourg (FMTS), 300 Boulevard Sébastien Brant, 67400, Illkirch-Graffenstaden, France.,Biochemistry and Molecular Biology Laboratory, Strasbourg University Hospital, 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - D Heitz
- Onco-geriatric Unit, Strasbourg University Hospital, 1 Avenue Molière, 67200, Strasbourg, France
| | - A-J Carin
- Gynecology Department, Haguenau General Hospital, 64 Avenue du Professeur Leriche, 67504, Haguenau, France
| | - N Thiébaut
- Quantmetry, 128 rue du Faubourg Saint-Honoré, 75008, Paris, France
| | - K Neuberger
- Quantmetry, 128 rue du Faubourg Saint-Honoré, 75008, Paris, France
| | - C Tomasetto
- Institue de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), CNRS, UMR7104 INSERM U964, 1 rue Laurent Fries, 67400, Illkirch-Graffenstaden, France
| | - C Mathelin
- Senology Unit, Strasbourg University Hospital, Hôpital de Hautepierre 1, Avenue Molière, 67200, Strasbourg, France.,Institue de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), CNRS, UMR7104 INSERM U964, 1 rue Laurent Fries, 67400, Illkirch-Graffenstaden, France.,Hôpital Saint Nicolas, Sarrebourg General Hospital, 25 Avenue du Général de Gaulle, 57400, Sarrebourg, France
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11
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Tumor characteristics and therapy of elderly patients with breast cancer. J Cancer Res Clin Oncol 2016; 142:1109-16. [PMID: 26809246 DOI: 10.1007/s00432-015-2111-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 12/28/2015] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Elderly breast cancer patients aged ≥75 years are underrepresented in most studies. Therefore, data on cancer characteristics, adjuvant treatment and survival in elderly patients are missing. PATIENTS AND METHODS In this retrospective study, we compared tumor characteristics and adjuvant therapy in 973 women with invasive, non-metastasized breast cancer aged ≥75 years with 3377 younger postmenopausal patients (50-74 years old). Time dynamics of tumor characteristics were investigated, comparing two observation periods between the years 2000-2004 versus 2005-2008. RESULTS Compared to younger women, older patients were more often treated with mastectomy and less likely to receive adjuvant treatment. Although the overall survival rate increased over the observation period in both age groups, the older study group was characterized by shorter disease-free survival. Additionally, we observed an increase in about 1.65 years in the age at diagnosis as well as an increasing rate of breast-conserving surgery and sentinel lymph node biopsy for the whole study population between 2000 and 2008. Furthermore, we found a reduction in the proportion of estrogen receptor-positive tumors in the younger women and a decrease in G3-tumors in both age groups over the study time. CONCLUSION The older group's reduced disease-free survival could be explained by the tumor characteristics and differences in the adjuvant treatment. Remarkably, elderly women are more likely to be overtreated surgically while being undertreated in terms of adjuvant therapy.
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12
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Lucas DJ, Sabino J, Shriver CD, Pawlik TM, Singh DP, Vertrees AE. Doing More: Trends in Breast Cancer Surgery, 2005 to 2011. Am Surg 2015. [DOI: 10.1177/000313481508100133] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An increasing number of women may be choosing mastectomy over breast-conserving surgery for breast cancer as well as undergoing more bilateral resection, immediate reconstruction, and prophylactic operations. Women who had breast cancer operations between 2005 and 2011 were selected from the National Surgical Quality Improvement Program database. Annual trends were explored using robust Poisson multivariable regression as were predictors for mastectomy versus breast-conserving surgery. A total of 85,401 women were identified. Mastectomy increased from 2005 to 2011, starting at 40 per cent in 2005 and peaking at 51 per cent in 2008 ( P < 0.001). Bilateral resection, immediate reconstruction, and prophylactic mastectomy also increased (all P < 0.001). Independent predictors of mastectomy included young age, Asian race, invasive cancer (vs carcinoma in situ), bilateral resection, axillary dissection, higher American Society of Anesthesiologists class, and lower body mass index (all P < 0.001). There was an increase in mastectomy, bilateral resection, immediate reconstruction, and prophylactic mastectomy from 2005 to 2011.
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Affiliation(s)
- Donald J. Lucas
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Jennifer Sabino
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Craig D. Shriver
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | | | - Amy E. Vertrees
- Walter Reed National Military Medical Center, Bethesda, Maryland
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13
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Benditte-Klepetko HC, Lutgendorff F, Kästenbauer T, Deutinger M, van der Horst CMAM. Analysis of patient satisfaction and donor-site morbidity after different types of breast reconstruction. Scand J Surg 2014; 103:249-55. [DOI: 10.1177/1457496913512829] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background and Aims: Breast reconstruction has been shown to improve quality of life. However, factors involved in long-term patient satisfaction are largely unknown. Our aim was to evaluate patient satisfaction and donor-site morbidity in five types of breast reconstruction. Material and Methods: A prospectively collected database of all breast surgery patients at Hospital Rudolfstiftung, Vienna, Austria, was searched for five types of breast reconstruction (2000–2006): implant, latissimus dorsi-flap, latissimus dorsi-flap with implant, free transverse rectus abdominis musculocutaneous-flap, and deep inferior epigastric perforator-flap. Patients were sent a study-specific questionnaire to assess satisfaction. Short-form 36-item health survey was used to analyze (quality of life), and complication data were retrieved from the database and assessed during a follow-up visit. Results: There were 257 patients identified, of whom, 126 responded to the survey (17 implant, 5 latissimus dorsi + implant, 64 latissimus dorsi, 22 transverse rectus abdominis musculocutaneous, and 18 deep inferior epigastric perforator reconstructions). No statistical differences were found in complication or reoperation rates. Deep inferior epigastric perforator–flap patients were significantly more satisfied compared to patients from the implant group ( p = 0.007). However, there was no significant difference regarding quality of life scores among the groups. After logistic regression analysis, only “impairment on daily life” showed to be independently correlated with patient satisfaction. This contrary to both operation type and complication rate which did not correlate with patient satisfaction. Conclusions: Our results indicate that operation type, complication rate, and revision rate did not independently correlate with patient satisfaction. Therefore, to further improve patient satisfaction, future research should be focused on other pro-operative factors, for example, patient education, expectations, and personality characteristics.
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Affiliation(s)
- H. C. Benditte-Klepetko
- Department of Plastic and Reconstructive Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Plastic and Reconstructive Surgery, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - F. Lutgendorff
- Department of Plastic and Reconstructive Surgery, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - T. Kästenbauer
- Science Consulting & Clinical Monitoring Institution, Vienna, Austria
| | - M. Deutinger
- Department of Plastic and Reconstructive Surgery, Hospital Rudolfstiftung, Vienna, Austria
| | - C. M. A. M. van der Horst
- Department of Plastic and Reconstructive Surgery, Amsterdam Medical Center, Amsterdam, The Netherlands
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14
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Porter G, Wagar B, Bryant H, Hewitt M, Wai E, Dabbs K, McFarlane A, Rahal R. Rates of breast cancer surgery in Canada from 2007/08 to 2009/10: retrospective cohort study. CMAJ Open 2014; 2:E102-8. [PMID: 25077125 PMCID: PMC4114057 DOI: 10.9778/cmajo.20130025] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Surgery is a common and important component of breast cancer treatment. We assessed the rates of breast cancer surgery across Canada from 2007/08 to 2009/10. METHODS We used hospital and day surgery data from the Canadian Institute for Health Information to assemble a cohort of women who had undergone breast cancer surgery. We identified the index surgical procedure and subsequent surgical procedures performed within 1 year for each woman included in the analysis. We calculated the crude mastectomy rate for each province, and we calculated the adjusted mastectomy rate for select jurisdictions using a logistic regression model fitted using age, neighbourhood income quintile and travel time. RESULTS In total, 57 840 women underwent breast cancer surgery during the study period. Among women with unilateral invasive breast cancer, the crude mastectomy rate was 39%. Adjusted rates for mastectomy varied widely by province (26%-69%). The rate of re-excision within 1 year for women who had breast-conserving surgery as their index procedure was 23% and varied by province in terms of frequency and type (mastectomy or repeat breast-conserving surgery). Among women who underwent mastectomy for unilateral invasive breast cancer, 6% also underwent contralateral prophylactic mastectomy, and 7% had immediate breast reconstruction following surgery. Of mastectomy procedures, 20% were performed as day surgery; for breast-conserving surgery, 70% were performed as day surgery. INTERPRETATION There is substantial interprovincial variation in surgical care for breast cancer in Canada. Further research is needed to better understand such variation, and continued monitoring should be the focus of quality initiatives.
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Affiliation(s)
- Geoff Porter
- Surgical Oncology, Dalhousie University, Halifax NS
| | - Brandon Wagar
- Canadian Institute for Health Information, Ottawa, Ont
- School of Health Information Science, University of Victoria, Victoria, BC
| | - Heather Bryant
- Cancer Control, Canadian Partnership Against Cancer, Toronto, Ont
| | - Maria Hewitt
- Canadian Institute for Health Information, Ottawa, Ont
| | - Elaine Wai
- Faculty of Medicine, University of British Columbia, Vancouver BC
- BC Cancer Agency (BCCA) — Vancouver Island Centre, Victoria, BC
| | - Kelly Dabbs
- Division of General Surgery, University of Alberta, Edmonton, Alta
| | - Anne McFarlane
- Western Canada and Development Initiatives, Canadian Institute for Health Information, Ottawa, Ont
| | - Rami Rahal
- System Performance and Surveillance, Canadian Partnership Against Cancer, Toronto, Ont
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Abstract
BACKGROUND With increasing rates of postmastectomy breast reconstruction, it has been suggested that there is an insufficient supply of services that meet patient demands. This study aimed to identify potential disparities in, and variables associated with, postmastectomy reconstruction in Japan. METHODS Using 20,257 Japanese breast cancer discharge data from 2010, the authors identified 1616 breast cancer patients, with tumor-node-metastasis classification of malignant tumors T1~4 and N0M0, between 20 and 59 years of age. Factors influencing the use of immediate breast reconstruction of either autogenous tissue or tissue expander placement were analyzed using multinomial logistic regression comparing no reconstruction to either autogenous tissue or tissue expander placement. RESULTS The immediate breast reconstruction rate was 11.2 percent among the study patients. The rate of autogenous method use was 49 percent and the rate of tissue expander use was 51 percent. Tissue expander placement was performed primarily in patients who resided in cities (OR, 2.4; 95 percent confidence interval, 1.5 to 4.1) and was performed at city hospitals. Patients who lived in rural areas primarily underwent autogenous tissue reconstruction, traveled to city hospitals to undergo surgery (OR, 2.0; 95 percent confidence interval, 1.0 to 4.0), and had normal body mass index (OR, 1.9; 95 percent confidence interval, 1.1 to 3.1). CONCLUSIONS The authors identified potential disparities associated with breast reconstruction. These disparities might be due to limited surgery methods and might have excluded some patients because of their age, physical, and economic status. Uneven distribution of plastic surgeons might have required patients to travel for breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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16
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Azzopardi J, Walsh D, Chong C, Taylor C. Impact of geographic location on surgical outcomes of women with breast cancer. ANZ J Surg 2014; 84:735-9. [PMID: 24438049 DOI: 10.1111/ans.12514] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this study is to use the Breast Surgeons of Australia and New Zealand Quality Audit to evaluate the diagnostic work up and surgical treatment path for Australian women with early breast cancer in relation to geographic location. METHODS We accessed data on patient geographic demographics, diagnostic and surgical procedures and cancer characteristics in 115,872 episodes of early breast cancer reported to the Quality Audit between 1998 and 2012. Tumour size, grade and number, lymph node positivity and lymphovascular invasion are the major prognostic factors adjusted for. RESULTS Core biopsy is the most frequently performed diagnostic method and open biopsy the least (P=0.001). Remote locations have the highest proportion of open biopsies and cities the lowest (13.8 versus 9.8%, P=0.001). The outer regional/remote patient group has a higher likelihood of an open biopsy than city patients (odds ratio 1.5; 95% confidence interval 1.1-2.2 P=0.02). Reconstruction rates are low throughout ranging from 3 to 4% (P=0.001). Cities have the highest proportion of no surgery (1.5%, P=0.001). Cities have the highest proportion of breast conserving surgery and the remote the lowest (64.5% versus 29.9%, P=0.001). Outer regional locations have the highest proportion of mastectomies and cities the lowest (38 versus 29.9%, P=0.001). The likelihood of receiving radiotherapy is associated with geographic location of residence and geographic distribution of the radiotherapy facility (P=0.002, P=0.001). CONCLUSION Geographic location of residence is associated with the diagnostic work up and surgical treatment of Australian women with early breast cancer.
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17
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Sim Y, Tan VKM, Ho GH, Wong CY, Madhukumar P, Tan BKT, Yong WS, Ng YYR, Ong KW. Contralateral prophylactic mastectomy in an Asian population: a single institution review. Breast 2013; 23:56-62. [PMID: 24275318 DOI: 10.1016/j.breast.2013.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 10/10/2013] [Accepted: 10/28/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Contralateral prophylactic mastectomy (CPM) removes the non-diseased breast in women who have unilateral breast cancer. This reduces the incidence of contralateral breast cancer, and potentially improves survival in high risk patients. Such surgical risk-reduction strategy is increasingly being adopted in the United States, despite a decreasing incidence of contralateral breast cancer. The use of CPM in an Asian population is yet unknown. We present the first Asian report on CPM rates and trends in Singapore, the country with the highest incidence of breast cancer in Asia. METHODS A retrospective review of all patients who had breast cancer surgery from 2001 to 2010 at the largest healthcare system in Singapore was performed. Patient demographics and tumour characteristics were analysed with regards to type of surgery performed. Factors associated with CPM were identified. RESULTS From 2001 to 2010, a total of 5130 patients underwent oncological breast surgery. A decreasing trend of mastectomies (82.7%-70.8%), an upward trend of breast conserving surgery (BCS) (17.3%-29.2%) and an increasing trend in CPM (0.46%-1.25%) is observed. Patients who opted for CPM are likely to be younger (48.4 ± 9.4 years), married (60%), parous (56.7%), with no family history of breast/ovarian cancer (66.7%), and diagnosed at an earlier stage. The rate of synchronous occult breast malignancy was found to be 10% (n = 30), and these were in patients who were of a low cancer-risk profile. CONCLUSIONS This retrospective study reflects an increasing incidence of breast cancer in Singapore, with a decrease in mastectomies, and an increase in BCS and CPM rates, similar to Western data. Similar to Western populations, the Asian woman who opts for CPM is likely to be young and have an earlier stage of breast cancer. In contrast, the Asian woman is likely to have no family history of breast or ovarian cancers. Commonly cited reasons for increased CPM rates such as the increased availability of genetic counselling and pre-operative MRI evaluation, along with wide use of reconstruction, do not feature as dominant factors in our population, suggesting that the Asian patients may have different considerations when electing for CPM.
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Affiliation(s)
- Yirong Sim
- Department of Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Veronique Kiak Mien Tan
- Department of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610, Singapore
| | - Gay Hui Ho
- Department of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610, Singapore
| | - Chow Yin Wong
- Department of Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Preetha Madhukumar
- Department of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610, Singapore
| | - Benita Kiat Tee Tan
- Department of Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Wei Sean Yong
- Department of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610, Singapore
| | - Yvonne Ying Ru Ng
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore 119228, Singapore
| | - Kong Wee Ong
- Department of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610, Singapore.
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18
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Chong C, Walters D, de Silva P, Taylor C, Spillane A, Kollias J, Pyke C, Campbell I, Maddern G. Initial axillary surgery: results from the BreastSurgANZ Quality Audit. ANZ J Surg 2013; 85:777-82. [PMID: 24251959 DOI: 10.1111/ans.12455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND The aim of this study was to establish the preference and reasons for initial axillary surgery performed on women with invasive breast cancer in Australia and New Zealand using data from the Breast Surgeon's Society of Australia and New Zealand Quality Audit (BQA) according to whether sentinel lymph node (SLN) biopsy, axillary lymph node dissection (ALND) or no axillary surgery was used. METHODS Patient data from 1999 to 2011 were categorized according to primary tumour size (≤3 cm or >3 cm) and analysed by year of diagnosis, type of initial axillary surgery and frequency of second axillary surgery following SLN biopsy. Patient age at diagnosis, health insurance status, surgeon caseload and hospital location were also examined as factors affecting the likelihood of performing different types of axillary surgery. RESULTS Seventy thousand six hundred and eighty-eight episodes of early breast cancer with axillary surgery data were reported to the BQA in the study period. The proportion of patients undergoing SLN biopsy as the first operation increased over this period in both tumour size groups with a concomitant decline in the use of ALND as the first operation over the same interval. Elderly women (>70 years old) were four times less likely to undergo axillary surgery for their initial management when compared with women aged 41-70 years old (P < 0.001). Factors favouring ALND as the initial surgery over SLN biopsy included larger tumour size, elderly age, uninsured status and having surgery in a regional centre. CONCLUSIONS From 1999 to 2011, SLN biopsy as the initial axillary surgery has been widely adopted by surgeons reporting to the BQA. Future evaluation of the BQA data in the following 3-5 years will be performed to monitor this progression.
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Affiliation(s)
- Chilton Chong
- Department of Surgery, The Queen Elizabeth Hospital, Woodville West, South Australia, Australia
| | - David Walters
- Department of Surgery, The Queen Elizabeth Hospital, Woodville West, South Australia, Australia.,BreastSurgANZ Quality Audit, Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia
| | - Primali de Silva
- BreastSurgANZ Quality Audit, Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia
| | - Corey Taylor
- BreastSurgANZ Quality Audit, Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia
| | - Andrew Spillane
- University of Sydney, Breast & Surgical Oncology at the Poche Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - James Kollias
- Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Chris Pyke
- Department of Surgery, Mater Hospital, South Brisbane, Queensland, Australia
| | - Ian Campbell
- Faculty of Medical and Health Sciences, Waikato Clinical School, University of Auckland, Auckland, New Zealand
| | - Guy Maddern
- National Quality Audit, Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia
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19
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Chong C, Walters D, de Silva P, Taylor C, Spillane A, Kollias J, Pyke C, Campbell I, Maddern G. Subsequent axillary surgery after sentinel lymph node biopsy: results from the BreastSurgANZ Quality Audit 2006-2010. Breast 2013; 22:1215-9. [PMID: 24157405 DOI: 10.1016/j.breast.2013.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 08/19/2013] [Accepted: 09/22/2013] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To use data from the BreastSurgANZ Quality Audit (BQA) to examine the patterns of completion axillary lymph node dissection (cALND) after sentinel lymph node (SLN) biopsy in women treated for early breast cancer in Australia and New Zealand and to compare it to the Australian and New Zealand guidelines in cases of both positive and negative SLN results. MATERIALS AND METHODS Patients were sub grouped as having primary tumours ≤3 cm and >3 cm and further analysed according to year of surgery, SLN status and final nodal status where cALND was recorded. Multivariate analysis was performed examining tumour size, grade, presence of lymphovascular invasion (LVI), HER2 and oestrogen receptor status, patient age and number of positive sentinel nodes as predictors for subsequent axillary surgery. RESULTS 14879 patients were identified from 2006 to 2010. 79.8% of patients with a positive SLN result underwent cALND. Age >70 years and a greater number of involved SLN predicted no cALND among SLN positive patients. 10.3% of patients who had a negative SLN result underwent cALND. Younger age, higher grade, lymphovascular invasion and tumour size >3 cm predicted cALND among SLN negative patients. CONCLUSIONS According to the BQA from 2006 to 2010 the Australian and New Zealand guideline recommendations for SLN positive patients to have cALND and SLN negative patients not to have cALND were adhered to in 79.8% and 89.7% of cases respectively.
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Affiliation(s)
- Chilton Chong
- Department of Surgery, The Queen Elizabeth Hospital, South Australia, Australia.
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20
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Azzopardi J, Walsh D, Chong C, Taylor C. Surgical treatment for women with breast cancer in relation to socioeconomic and insurance status. Breast J 2013; 20:3-8. [PMID: 24164659 DOI: 10.1111/tbj.12203] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Based on the National Breast Cancer Audit of the Royal Australasian College of Surgeons an association between patient age and type of breast cancer surgery received has already been demonstrated. The aim of this study is to assess the patterns of surgical treatment for women with early breast cancer in relation to socioeconomic and insurance status. Data on patient demographics, diagnostic, and surgical procedures and cancer characteristics in 115,872 episodes of early breast cancer reported to the National Breast Cancer Audit between 1998 and 2012 is used for this study. Tumor size, histologic grade, number of tumors, lymph node positivity, and lymphovascular invasion are the major prognostic factors adjusted for. Reconstruction following mastectomy is the most likely surgical procedure for the higher socioeconomic and privately insured patients. Mastectomy alone is the most likely surgical procedure for the lower socioeconomic and for public patients. No surgery is the most likely surgical outcome for the lower socioeconomic and the least likely for the higher socioeconomic population. Open biopsy is the most likely diagnostic procedure for the lower socioeconomic and fine needle aspiration for the higher socioeconomic population. Socioeconomic and insurance status, are both independently associated with the types of treatment and diagnostic procedure for women with breast cancer. Opportunities present to investigate an association of these factors with morbidity and survival outcomes.
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Affiliation(s)
- Jonathan Azzopardi
- Lyell McEwin Hospital, Division of Surgery, Adelaide, South Australia, Australia
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21
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Cappellani A, Vita MD, Zanghì A, Cavallaro A, Piccolo G, Majorana M, Barbera G, Berretta M. Prognostic factors in elderly patients with breast cancer. BMC Surg 2013; 13 Suppl 2:S2. [PMID: 24268048 PMCID: PMC3851261 DOI: 10.1186/1471-2482-13-s2-s2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Breast cancer (BC) remains principally a disease of old ages; with 35-50% of cases occurring in women older than 65 years. Even mortality for cancer increases with aging: 19.7% between 65 and 74 years; 22.6% between 75 and 84 years; and 15.1% in 85 years or more. METHODS A search was performed on Medline, Embase, Scopus using the following Key words: Breast cancer, Breast neoplasms, Aged, Elder, Elderly, Eldest, Older, Survival analysis, Prognosis, Prognostic factors, Tumor markers, Biomarkers, Comorbidity, Geriatric assessment, Axilla, Axillary surgery. 3029 studies have been retrieved. Paper in which overall or disease free survival were not end points, or age class was not well defined, or the sample was too small, were excluded. At last 42 papers fulfilled the criteria. RESULTS AND DISCUSSION Lack of screening and delay in diagnosis may be responsible for the minor improvement in survival observed in elderly respect to younger breast cancer patients. Predictive factors are the same and must be assessed with the same attention reserved to younger women. CONCLUSIONS Most of elderly patient are fit to undergo standard treatment and can get the same benefits of younger women. Nevertheless it is possible that some older women with early breast cancer can be spared too aggressive treatments. Geriatric assessment and co-morbidities can affect the prognosis modifying surveillance, life expectancy and compliance to therapies. They can thus be useful to select the better treatment, either surgical or radio or hormone - or chemo-therapy.
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Affiliation(s)
- Alessandro Cappellani
- Department of Surgery, General and Breast Surgery Unit, University of Catania, Catania, Italy
| | - Maria Di Vita
- Department of Surgery, General and Breast Surgery Unit, University of Catania, Catania, Italy
| | - Antonio Zanghì
- Department of Surgery, General and Breast Surgery Unit, University of Catania, Catania, Italy
| | - Andrea Cavallaro
- Department of Surgery, General and Breast Surgery Unit, University of Catania, Catania, Italy
| | - Gaetano Piccolo
- Department of Surgery, General and Breast Surgery Unit, University of Catania, Catania, Italy
| | - Marcello Majorana
- Department of Radiology, Mediterranean Institute of Oncology, Viagrande, (CT), Italy
| | - Giuseppina Barbera
- Department of Surgery, General and Breast Surgery Unit, University of Catania, Catania, Italy
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Kaur P, Santillan AA, McGuire K, Turaga KK, Shamehdi C, Meade T, Ramos D, Mathias M, Parbhoo J, Davis M, Khakpour N, King J, Balducci L, Cox CE. The Surgical Treatment of Breast Cancer in the Elderly: A Single Institution Comparative Review of 5235 Patients with 1028 Patients ≥70 years. Breast J 2012; 18:428-35. [DOI: 10.1111/j.1524-4741.2012.01272.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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23
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Breast reconstruction following mastectomy for invasive breast cancer is strongly influenced by demographic factors in women in Victoria, Australia. Breast 2012; 21:394-400. [DOI: 10.1016/j.breast.2012.04.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 04/04/2012] [Accepted: 04/18/2012] [Indexed: 11/17/2022] Open
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Damle S, Teal CB, Lenert JJ, Marshall EC, Pan Q, McSwain AP. Mastectomy and contralateral prophylactic mastectomy rates: an institutional review. Indian J Surg Oncol 2011; 2:133-40. [PMID: 22696239 PMCID: PMC3373170 DOI: 10.1007/s13193-011-0086-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Indexed: 01/06/2023] Open
Abstract
Background. Breast conservation surgery (BCS) followed by radiation is as effective as mastectomy for long-term survival and is considered standard of care for early-stage breast cancer. An increasing number of patients are opting for cancer-side mastectomies (CM) and often contralateral prophylactic mastectomies (CPM). Our study investigates if there are increasing trends in our patient population toward CM and CPM and identifies common factors associated with those electing to have more extensive surgery.Methods. A retrospective analysis was performed on 812 breast cancer surgeries between January 2001 and December 2009 at The George Washington University Breast Care Center. BCS-eligible patients who elected to have BCS were compared with those who chose CM. Patients who underwent CM were compared with patients undergoing CM and CPM.Results. A personal or family history of breast cancer and larger tumor size were positively associated with choosing CM in BCS-eligible patients. A nonstatistically significant trend toward CM was seen in younger patients. Age, family history, fewer children, Caucasian race, and reconstructive surgery were positively associated with choosing CPM.Conclusion. Mastectomy rates at this institution have not shown the recent sharp increase observed by some authors. The association of age, race, family history, and parity with CPM has been corroborated in multiple studies. However, there is disagreement between statistically significant findings among investigators evaluating factors associated with CPM, and there is limited data in the literature characterizing BCS-eligible patients who chose CM. Larger prospective studies are necessary to further evaluate CM and CPM rates.
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Affiliation(s)
- Sameer Damle
- Department of Surgery, Breast Care Center, The George Washington University, Washington, DC USA
| | - Christine B. Teal
- Department of Surgery, Breast Care Center, The George Washington University, Washington, DC USA
| | - Joanne J. Lenert
- Department of Surgery, Division of Plastic Surgery, The George Washington University, Washington, DC USA
| | - Elizabeth C. Marshall
- Department of Surgery, Division of Plastic Surgery, The George Washington University, Washington, DC USA
| | - Qing Pan
- Department of Statistics, Biostatistics Center, The George Washington University, Washington, DC USA
| | - Anita P. McSwain
- Department of Surgery, Breast Care Center, The George Washington University, Washington, DC USA
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Damle S, Teal CB, Lenert JJ, Marshall EC, Pan Q, McSwain AP. Mastectomy and Contralateral Prophylactic Mastectomy Rates: An Institutional Review. Ann Surg Oncol 2010; 18:1356-63. [DOI: 10.1245/s10434-010-1434-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Indexed: 01/06/2023]
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Puts MTE, Monette J, Girre V, Wolfson C, Monette M, Batist G, Bergman H. Quality of life during the course of cancer treatment in older newly diagnosed patients. Results of a prospective pilot study. Ann Oncol 2010; 22:916-923. [PMID: 20924079 DOI: 10.1093/annonc/mdq446] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The aim of this prospective study was to report the quality of life (QoL) of older cancer patients during the first year after diagnosis and factors influencing QoL. PATIENTS AND METHODS Newly diagnosed patients aged ≥65 years were recruited for a pilot prospective cohort study at the Jewish General Hospital, Montreal, Canada. Participants were interviewed at baseline, and at 1.5, 3, 4.5, 6, and 12 months. QoL was assessed at each interview using the European Organization for the Research and Treatment of Cancer Quality of Life Core Questionnaire with 30 items. Logistic regression was conducted to determine which sociodemographic, health, and functional status characteristics were associated with decline in global health status/QoL between baseline and 12-month follow-up. RESULTS There were 112 participants at baseline (response rate 72%), median age of 74.1, and 70% were women. Between baseline and 12-month follow-up (n=78), 18 participants (23.1%) declined ≥10 points in global health status/QoL, while 34 participants (43.6%) remained stable and 23 participants (33.3%) improved ≥10 points. None of the sociodemographic, health, and functional status variables were associated with decline in logistic regression analyses. CONCLUSION Almost 25% of older adults experienced clinically relevant decline in their QoL. Further research is needed on which factors influence decline in QoL in older adults.
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Affiliation(s)
- M T E Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto; Solidage Research Group on Frailty and Aging, McGill University/Université de Montreal, Jewish General Hospital, Montreal.
| | - J Monette
- Solidage Research Group on Frailty and Aging, McGill University/Université de Montreal, Jewish General Hospital, Montreal; Division of Geriatric Medicine, Jewish General Hospital, McGill University, Montreal; Department of Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Canada
| | - V Girre
- Solidage Research Group on Frailty and Aging, McGill University/Université de Montreal, Jewish General Hospital, Montreal; Department of Medical Oncology, Institut Curie, Paris, France
| | - C Wolfson
- Division of Clinical Epidemiology, McGill University Health Centre, McGill University, Montreal, Canada
| | - M Monette
- Solidage Research Group on Frailty and Aging, McGill University/Université de Montreal, Jewish General Hospital, Montreal
| | - G Batist
- Department of Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Canada
| | - H Bergman
- Solidage Research Group on Frailty and Aging, McGill University/Université de Montreal, Jewish General Hospital, Montreal; Division of Geriatric Medicine, Jewish General Hospital, McGill University, Montreal; Department of Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Canada
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