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Fancellu A, Deiana G, Sanna V, Rubino C, Cossu A, Cottu P, Giuliani G, Sant L, Norcia G, Porcu A. Rising age-specific rates of immediate breast reconstruction after mastectomy: Report from an Italian Breast Unit. J Surg Oncol 2023; 128:1227-1234. [PMID: 37592864 DOI: 10.1002/jso.27420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/29/2023] [Accepted: 08/09/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Immediate breast reconstruction (IBR) represents a fundamental part in the management of patients receiving mastectomy. In recent years, there has been an increasing trend in the use of IBR in all age groups. The study aims were to evaluate the age-specific trend of IBR, and to discuss its effects in work organization at an Italian Breast Unit. METHODS We searched for women diagnosed with breast cancer between 2010 and 2019, focusing on IBR rates in patients who received mastectomy. Age-specific trends were assessed using the Cochrane-Armitage test. Differences in operative times and hospital stay between women undergoing mastectomy + IBR (Ma + IBR) or mastectomy alone (Ma) were evaluated by Student's t test or χ2 test. RESULTS Among 1915 patients, 62.4% underwent breast conserving surgery (BCS), and 37.6% mastectomy. Overall, rates of Ma + IBR increased from 32% in 2010 to 58% in 2019 (p < 0.001). Although rates of IBR rose in all age groups, the trend was significantly increased among patients aged 50-59 (p < 0.001), 60-69 (p < 0.0001), and 70-79 (p < 0.05). CONCLUSIONS Rates of Ma + IBR have increased over years, especially among older women. Ma + IBR resulted in longer operative times and hospital stay than Ma alone. These findings imply that, in the near future, resources should be implemented to improve and strengthen the surgical activity of Breast Units, to support the increasing use of IBR in women of all age groups.
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Affiliation(s)
- Alessandro Fancellu
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - Giulia Deiana
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - Valeria Sanna
- AOU Sassari, Department of Oncohematology, Unit of Medical Oncology, Sassari, Italy
| | - Corrado Rubino
- Department of Medicine, Surgery and Pharmacy, Unit of Plastic Surgery, University of Sassari, Sassari, Italy
| | - Antonio Cossu
- Department of Medicine, Surgery and Pharmacy, Unit of Pathology, University of Sassari, Sassari, Italy
| | - Pietrina Cottu
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - Giuliana Giuliani
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - Lisa Sant
- Faculty of Medicine and Surgery, University of Sassari Medical School, Sassari, Italy
| | - Giuseppe Norcia
- Faculty of Medicine and Surgery, University of Sassari Medical School, Sassari, Italy
| | - Alberto Porcu
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari, Italy
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Drivas E, Gachabayov M, Kajmolli A, Stadlan Z, Felsenreich DM, Castaldi M. Quilting Suture Technique After Mastectomy: A Meta-Analysis. Am Surg 2023; 89:6045-6052. [PMID: 37144600 DOI: 10.1177/00031348231173995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND There is no level 1a evidence testing quilting suture (QS) technique after mastectomy on wound outcomes. The aim of this systematic review and meta-analysis evaluates QS and association with surgical site occurrences as compared to conventional closure (CC) for mastectomy. METHODS MEDLINE, PubMed, and Cochrane Library were systematically searched to include adult women with breast cancer undergoing mastectomy. The primary endpoint was postoperative seroma rate. Secondary endpoints included rates of hematoma, surgical site infection (SSI), and flap necrosis. The Mantel-Haenszel method with random-effects model was used for meta-analysis. Number needed to treat was calculated to assess clinical relevance of statistical findings. RESULTS Thirteen studies totaling 1748 patients (870 QS and 878 CC) were included. Seroma rates were statistically significantly lower in patients with QS (OR [95%CI] = .32 [.18, .57]; P < .0001) than CC. Hematoma rates (OR [95%CI] = 1.07 [.52, 2.20]; P = .85), SSI rates (OR [95%CI] = .93 [.61, 1.41]; P = .73), and flap necrosis rates (OR [95%CI] = .61 [.30, 1.23]; P = .17) did not significantly vary between QS and CC. CONCLUSION This meta-analysis found that QS was associated with significantly decreased seroma rates when compared to CC in patients undergoing mastectomy for cancer. However, improvement in seroma rates did not translate into a difference in hematoma, SSI, or flap necrosis rates.
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Affiliation(s)
- Eleni Drivas
- Department of Surgery, Westchester Medical Center, Valhalla, NY, USA
| | - Mahir Gachabayov
- Department of Surgery, Westchester Medical Center, Valhalla, NY, USA
| | - Agon Kajmolli
- Department of Surgery, Westchester Medical Center, Valhalla, NY, USA
| | - Zehavya Stadlan
- Department of Surgery, New York Medical College, Valhalla, NY, USA
| | | | - Maria Castaldi
- Department of Surgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Surgery, New York Medical College, Valhalla, NY, USA
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Cinquini M, Rocco N, Catanuto G, Garreffa E, Ferrando PM, Gonzalez-Lorenzo M, Maglia A, Montagna G, Villanucci A, Visintini Cividin V, Nava MB. Should Acellular Dermal Matrices Be Used for Implant-based Breast Reconstruction after Mastectomy? Clinical Recommendation Based on the GRADE Approach. Plast Reconstr Surg Glob Open 2023; 11:e4821. [PMID: 36845868 DOI: 10.1097/GOX.0000000000004821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/20/2022] [Indexed: 02/24/2023]
Abstract
Acellular dermal matrices (ADMs) entered the market in the early 2000s and their use has increased thereafter. Several retrospective cohort studies and single surgeon series reported benefits with the use of ADMs. However, robust evidence supporting these advantages is lacking. There is the need to define the role for ADMs in implant-based breast reconstruction (IBBR) after mastectomy. Methods A panel of world-renowned breast specialists was convened to evaluate evidence, express personal viewpoints, and establish recommendation for the use of ADMs for subpectoral one-/two-stage IBBR (compared with no ADM use) for adult women undergoing mastectomy for breast cancer treatment or risk reduction using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Results Based on the voting outcome, the following recommendation emerged as a consensus statement: the panel members suggest subpectoral one- or two-stage IBBR either with ADMs or without ADMs for adult women undergoing mastectomy for breast cancer treatment or risk reduction (with very low certainty of evidence). Conclusions The systematic review has revealed a very low certainty of evidence for most of the important outcomes in ADM-assisted IBBR and the absence of standard tools for evaluating clinical outcomes. Forty-five percent of panel members expressed a conditional recommendation either in favor of or against the use of ADMs in subpectoral one- or two-stages IBBR for adult women undergoing mastectomy for breast cancer treatment or risk reduction. Future subgroup analyses could help identify relevant clinical and pathological factors to select patients for whom one technique could be preferable to another.
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Zhuang H, Wang L, Yu X, Chan SWC, Gao Y, Li X, Gao S, Zhu J. Effects of decisional conflict, decision regret and self-stigma on quality of life for breast cancer survivors: A cross-sectional, multisite study in China. J Adv Nurs 2022; 78:3261-3272. [PMID: 35396872 DOI: 10.1111/jan.15250] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/20/2022] [Accepted: 03/23/2022] [Indexed: 01/03/2023]
Abstract
AIMS To examine the differences in decisional conflict, decision regret, self-stigma and quality of life among breast cancer survivors who chose different surgeries, as well as the effects of decisional conflict, decision regret and self-stigma on quality of life. DESIGN Observational study. METHODS Paper and online surveys were used to collect data from March to September 2020. The Chinese version of the Decisional Conflict Scale, Decision Regret Scale, Self-Stigma Form and Functional Assessment of Cancer Treatment-B were used to measure the corresponding health outcomes for breast cancer survivors who chose different surgeries from three university-affiliated hospitals. One-way analysis of variance, Pearson's correlation coefficient and hierarchical multiple regression analysis were used for data analysis. RESULTS Among the 448 participants, only 21% chose breast conservative surgery, while 79% chose mastectomy with or without reconstruction. Women who chose mastectomy with reconstruction reported higher decisional conflict (p = .028) and more decision regret (p = .013) than women who chose breast conservative surgery; women who chose mastectomy without reconstruction indicated higher decisional conflict (p = .015), more decision regret (p < .001), and higher self-stigma (p = .034) than women who chose breast conservative surgery. Decisional conflict (r = -.430), decision regret (r = -.495), and self-stigma (r = -.561) were negatively correlated with quality of life. After controlling for sociodemographic and clinical variables, decisional conflict and decision regret explained 19.7% and self-stigma explained 12.9% of the variance in quality of life. CONCLUSION Decisional conflict, decision regret and self-stigma vary according to different breast surgeries and are greatly associated with the quality of life of breast cancer survivors. IMPACT Future studies are warranted to investigate the decision-making process and the underlying reasons for surgical choices. Decision support strategies pre-surgery are needed to inform women about the risks and benefits of surgery options. Moreover, psychosocial support post-surgery is warranted to relieve women's self-stigma, thus improving their quality of life.
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Affiliation(s)
- Hezhu Zhuang
- The First Affiliated Hospital, Fujian Medical University, Fujian Province, P. R. China
| | - Ling Wang
- Shenzhen Hospital, Peking University, Guangdong Province, P. R. China
| | - Xuefen Yu
- Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| | | | - Yixuan Gao
- Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Xiuqing Li
- Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Shan Gao
- Shenzhen Hospital, Peking University, Guangdong Province, P. R. China
| | - Jiemin Zhu
- Department of Nursing, School of Medicine, Xiamen University, Fujian Province, P. R. China
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Liu J, Hunter S, Zhu J, Lee RLT, Chan SW. Decision-Making Experience Related to Mastectomy Among Women With Breast Cancer: An Integrative Review. Cancer Nurs 2021. [PMID: 34294647 DOI: 10.1097/NCC.0000000000000981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND Deciding to have a mastectomy can be challenging for women. An understanding of the decision-making experience related to mastectomy would contribute to improving the support of women making this decision. OBJECTIVE The aim of this study was to understand women's decision-making experience related to mastectomy. METHODS Studies published from 2000 to 2020 were identified by searching databases (CINAHL, MEDLINE, EMBASE, PsycINFO, PubMed, Web of Science, and China National Knowledge Infrastructure) and reference lists of previous reviews. Methodological quality of these studies was assessed using the Mixed Methods Appraisal Tool version 2018. Data were analyzed using content comparison analysis. RESULTS Twenty-three quantitative and 6 qualitative studies were included in this review. Four themes emerged from the included studies: participation in decision-making, seeking information about treatment choices, postoperative perceptions of mastectomy decision-making, and factors related to mastectomy choice. Several negative experiences related to decision-making were identified. A number of clinical, sociodemographic, and psychosocial factors that influenced women to choose a mastectomy were identified. CONCLUSIONS This review provides in-depth information about decision-making experiences and factors that influence the choice of mastectomy. Research is required about women who have had a mastectomy using standardized instruments to investigate their decision-making experiences. Studies are also necessary in non-Western countries. IMPLICATIONS FOR PRACTICE The factors and experiences identified in this review may help nurses to assist in the treatment decision-making process. Further research is required regarding breast care and other nurses' involvement in the decision-making process related to mastectomy.
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Rocco N, Catanuto G, Chiodini P, Rispoli C, Nava MB. Implants versus autologous tissue flaps for breast reconstruction following mastectomy. Hippokratia 2021. [DOI: 10.1002/14651858.cd013821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Nicola Rocco
- G.Re.T.A. Group for Reconstructive and Therapeutic Advancements; Naples Italy
| | - Giuseppe Catanuto
- Multidisciplinary Breast Unit; Azienda Ospedaliera Cannizzaro; Catania Italy
- G.Re.T.A. Group for Reconstructive and Therapeutic Advancements; Catania Italy
| | - Paolo Chiodini
- Physical and Mental Health; University of Campania "Luigi Vanvitelli"; Napoli Italy
| | | | - Maurizio B Nava
- G.Re.T.A. Group for Reconstructive and Therapeutic Advancements; Milan Italy
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Al-Gaithy ZK, Yaghmoor BE, Koumu MI, Alshehri KA, Saqah AA, Alshehri HZ. Trends of mastectomy and breast-conserving surgery and related factors in female breast cancer patients treated at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, 2009-2017: A retrospective cohort study. Ann Med Surg (Lond) 2019; 41:47-52. [PMID: 31245000 DOI: 10.1016/j.amsu.2019.03.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/28/2019] [Accepted: 03/31/2019] [Indexed: 12/23/2022] Open
Abstract
Background Breast cancer is the most common cancer in women and accounts for 14.7% of cancer-related deaths among females worldwide. Its core management includes surgical removal of the tumor either by breast-conserving surgery (BCS) or mastectomy. Choosing between these two procedures may be influenced by factors that are not studied in our region. We aimed to determine the prevalence of BCS and mastectomy and the factors that may influence the choice of procedure. Methods This retrospective study was carried out by reviewing the records of female breast cancer patients who underwent BCS or mastectomy at between 2009 to June 2017, excluding those with metastasis or recurrence. Frequencies and multivariate tests were used for detecting correlations between procedures and demographic, clinicopathological, and radiological factors. Results Of 335 patients (mean age 52.75 ± 12.2 years), 62.4% had mastectomy and 37.6% had BCS. Modified radical mastectomy accounted for 70.8% of mastectomies. Multivariate analysis showed non-Saudi nationality (P = 0.002), multifocal (P = 0.0001) and multicentric tumors (P = 0.0001), large tumor size (P = 0.0001), tumor stages IIIA (P = 0.005) and IIIB (P = 0.014), positive HER2 (0.009), and triple-negative receptor status (P = 0.010) significantly correlated with mastectomy. Conclusion Mastectomy has a much higher prevalence than BCS in our study mainly due to advanced tumor stage at the time of diagnosis. This emphasizes the urgent need for early detection of breast cancer to move towards BCS, with education and increasing awareness of breast cancer and the surgical options, especially that it is more common in a significantly younger population in our area.
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Harding C, Pompei F, Burmistrov D, Wilson R. Use of Mastectomy for Overdiagnosed Breast Cancer in the United States: Analysis of the SEER 9 Cancer Registries. J Cancer Epidemiol 2019; 2019:5072506. [PMID: 30804999 DOI: 10.1155/2019/5072506] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 11/24/2018] [Accepted: 12/23/2018] [Indexed: 12/28/2022] Open
Abstract
Aim We investigated use of mastectomy as treatment for early breast cancer in the US and applied the resulting information to estimate the minimum and maximum rates at which mastectomy could plausibly be undergone by patients with overdiagnosed breast cancer. Little is currently known about overtreatments undergone by overdiagnosed patients. Methods In the US, screening is often recommended at ages ≥40. The study population was women age ≥40 diagnosed with breast cancer in the US SEER 9 cancer registries during 2013 (n=26,017). We evaluated first-course surgical treatments and their associations with case characteristics. Additionally, a model was developed to estimate probability of mastectomy conditional on observed case characteristics. The model was then applied to evaluate possible rates of mastectomy in overdiagnosed patients. To obtain minimum and maximum plausible rates of this overtreatment, we respectively assumed the cases that were least and most likely to be treated by mastectomy had been overdiagnosed. Results Of women diagnosed with breast cancer at age ≥40 in 2013, 33.8% received mastectomy. Mastectomy was common for most investigated breast cancer types, including for the early breast cancers among which overdiagnosis is thought to be most widespread: mastectomy was undergone in 26.4% of in situ and 28.0% of AJCC stage-I cases. These rates are substantively higher than in many European nations. The probability-based model indicated that between >0% and <18% of the study population could plausibly have undergone mastectomy for overdiagnosed cancer. This range reduced depending on the overdiagnosis rate, shrinking to >0% and <7% if 10% of breast cancers were overdiagnosed and >3% and <15% if 30% were overdiagnosed. Conclusions Screening-associated overtreatment by mastectomy is considerably less common than overdiagnosis itself but should not be assumed to be negligible. Screening can prompt or prevent mastectomy, and the balance of this harm-benefit tradeoff is currently unclear.
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Minicozzi P, Van Eycken L, Molinie F, Innos K, Guevara M, Marcos-Gragera R, Castro C, Rapiti E, Katalinic A, Torrella A, Žagar T, Bielska-Lasota M, Giorgi Rossi P, Larrañaga N, Bastos J, Sánchez MJ, Sant M. Comorbidities, age and period of diagnosis influence treatment and outcomes in early breast cancer. Int J Cancer 2018; 144:2118-2127. [PMID: 30411340 DOI: 10.1002/ijc.31974] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/26/2018] [Accepted: 10/23/2018] [Indexed: 12/17/2022]
Abstract
Survival for breast cancer (BC) is lower in eastern than northern/central Europe, and in older than younger women. We analysed how comorbidities at diagnosis affected whether selected standard treatments (STs) were given, across Europe and over time, also assessing consequences for survival/relapse. We analysed 7581 stage I/IIA cases diagnosed in 9 European countries in 2009-2013, and 4 STs: surgery; breast-conserving surgery plus radiotherapy (BCS + RT); reconstruction after mastectomy; and prompt treatment (≤6 weeks after diagnosis). Covariate-adjusted models estimated odds of receiving STs and risks of death/relapse, according to comorbidities. Pearson's R assessed correlations between odds and risks. The z-test assessed the significance of time-trends. Most women received surgery: 72% BCS; 24% mastectomy. Mastectomied patients were older with more comorbidities than BCS patients (p < 0.001). Women given breast reconstruction (25% of mastectomies) were younger with fewer comorbidities than those without reconstruction (p < 0.001). Women treated promptly (45%) were younger than those treated later (p = 0.001), and more often without comorbidities (p < 0.001). Receiving surgery/BCS + RT correlated strongly (R = -0.9), but prompt treatment weakly (R = -0.01/-0.02), with reduced death/relapse risks. The proportion receiving BCS + RT increased significantly (p < 0.001) with time in most countries. This appears to be the first analysis of the influence of comorbidities on receiving STs, and of consequences for outcomes. Increase in BCS + RT with time is encouraging. Although women without comorbidities usually received STs, elderly patients often received non-standard less prompt treatments, irrespective of comorbidities, with increased risk of mortality/relapse. All women, particularly the elderly, should receive ST wherever possible to maximise the benefits of modern evidence-based treatments.
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Affiliation(s)
- Pamela Minicozzi
- Analytical Epidemiology and Health Impact Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | - Florence Molinie
- Loire-Atlantique/Vendée Cancer Registry, Nantes, France.,SIRIC-ILIAD, CHU Nantes, Nantes, France
| | - Kaire Innos
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Marcela Guevara
- Navarra Cancer Registry, Public Health Institute of Navarra, IDISNA, Pamplona, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Rafael Marcos-Gragera
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Epidemiology Unit and Girona Cancer Registry, Department of Health, Catalan Institute of Oncology (ICO), Girona, Spain
| | - Clara Castro
- Department of Epidemiology, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal.,EpiUnit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Elisabetta Rapiti
- Geneva Cancer Registry, Global Health Institute, University of Geneva, Geneva, Switzerland
| | - Alexander Katalinic
- University of Lübeck, Institute for Social Medicine and Epidemiology, Lübeck, Germany
| | - Ana Torrella
- Castellón Cancer Registry, Epidemiology Unit, Public Health Department, Castellón, Spain
| | - Tina Žagar
- Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Magdalena Bielska-Lasota
- Department of Health Promotion and Prevention of Chronic Diseases, National Institute of Public Health (NIH), Warsaw, Poland
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Nerea Larrañaga
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Public Health Department of Gipuzkoa, Donostia, Spain
| | - Joana Bastos
- EpiUnit, Institute of Public Health, University of Porto, Porto, Portugal.,Portuguese Institute of Oncology Francisco Gentil (IPO Coimbra), Coimbra, Portugal
| | - Maria José Sánchez
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Andalusian School of Public Health, Granada Cancer Registry, Granada, Spain.,Biomedical Research Institute of Granada (ibs. Granada), Granada, Spain
| | - Milena Sant
- Analytical Epidemiology and Health Impact Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
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Fancellu A, Sanna V, Cottu P, Feo CF, Scanu AM, Farina G, Bulla A, Spanu A, Paliogiannis P, Porcu A. Mastectomy patterns, but not rates, are changing in the treatment of early breast cancer. Experience of a single European institution on 2315 consecutive patients. Breast 2018; 39:1-7. [PMID: 29454174 DOI: 10.1016/j.breast.2018.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 01/28/2018] [Accepted: 02/08/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Recent literature reports that rates of mastectomy are increasing in early breast cancer. However, data from European institutions are limited and revealed conflicting results. We report on 15-year trends of mastectomy, mastectomy plus immediate reconstruction and contralateral prophylactic mastectomy (CPM) at an academic institution. METHODS We identified women diagnosed with unilateral early breast cancer at stage 0-IIa, with tumour size ≤ 4 cm, between 2002 and 2016. Trends were assessed using the Cochrane-Armitage test. Multivariable logistic regression was used to identify factors associated with receipt of mastectomy plus immediate reconstruction. RESULTS A total of 2315 patients were identified. Of them, 65.7% underwent breast conserving surgery (BCS), while 34.3% underwent mastectomy as upfront surgery. Two point four per cent also received CPM. Immediate reconstruction was performed in 36.0% of patients receiving mastectomy. There was no change in trends of mastectomy over the 15 years studied (p = 0.69), as well as in trends of patients undergoing CPM (p = 0.44). In contrast, rates of immediate reconstruction rose significantly over the study period (from 12.2% in 2002 to 62.7% in 2016, p < 0.0001). Women were more likely to receive mastectomy plus immediate reconstruction if they were aged 50 years or younger, or had tumours larger than 2 cm, or had non-invasive carcinoma. CONCLUSIONS Our study suggests that rates of both mastectomy and CPM in early breast cancer are not increasing, while use of immediate reconstruction is on the rise.
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Affiliation(s)
- Alessandro Fancellu
- Unit of General Surgery 2-Clinica Chirurgica, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy.
| | - Valeria Sanna
- Unit of Medical Oncology, Department of Clinical and Experimental Medicine, University Sassari, Sassari, Italy
| | - Pietrina Cottu
- Unit of General Surgery 2-Clinica Chirurgica, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Cladio F Feo
- Unit of General Surgery 2-Clinica Chirurgica, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Antonio M Scanu
- Unit of General Surgery 2-Clinica Chirurgica, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Giulia Farina
- Unit of General Surgery 2-Clinica Chirurgica, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Antonio Bulla
- Unit of Plastic Surgery, Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Sassari, Italy
| | - Angela Spanu
- Unit of Nuclear Medicine, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Panagiotis Paliogiannis
- Unit of Experimental Pathology and Oncology, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Alberto Porcu
- Unit of General Surgery 2-Clinica Chirurgica, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
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Abstract
Significant technologic advances in radiation treatment delivery now allow for more personalized delivery considerations which incorporate individual patient characteristics (such as tumor location and patient anatomy) and more precise delivery in the breast conservation or post-mastectomy setting. The combined advancements with other treatment modalities (i.e., systemic therapy, surgical management) have had direct effects on local-regional management and outcomes such that currently, local-regional relapses after definitive treatment for localized disease are now rarely experienced. Recent advances in the radiation therapy field have come from careful patient selection for a variety of three-dimensional treatment delivery techniques and alternatives to conventional tangential radiation. These advances have been demonstrated to diminished acute/long-term toxicity, minimized dose to surrounding normal tissue structures such as the heart and lung, and ultimately result in an improvement in the therapeutic ratio for radiation treatment. This chapter discusses recent radiation innovations and appropriate patient selection for their application, for a more personalized approach to radiation therapy for breast cancer patients.
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Affiliation(s)
- Meena S Moran
- Therapeutic Radiology, Yale Radiation Therapy Program, Yale University School of Medicine, New Haven, USA.
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12
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Rococo E, Mazouni C, Or Z, Mobillion V, Koon Sun Pat M, Bonastre J. Variation in rates of breast cancer surgery: A national analysis based on French Hospital Episode Statistics. Eur J Surg Oncol 2016; 42:51-8. [DOI: 10.1016/j.ejso.2015.09.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/17/2015] [Accepted: 09/21/2015] [Indexed: 11/25/2022] Open
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Seshie B, Adu-Aryee NA, Dedey F, Calys-Tagoe B, Clegg-Lamptey JN. A retrospective analysis of breast cancer subtype based on ER/PR and HER2 status in Ghanaian patients at the Korle Bu Teaching Hospital, Ghana. BMC Clin Pathol 2015; 15:14. [PMID: 26161039 PMCID: PMC4496863 DOI: 10.1186/s12907-015-0014-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 06/29/2015] [Indexed: 01/05/2023] Open
Abstract
Background Breast cancer is a heterogeneous disease composed of multiple subgroups with different molecular alterations, cellular composition, clinical behaviour, and response to treatment. This study evaluates the occurrence of the various subtypes and their clinical and pathological behaviour in the Ghanaian breast cancer population at the Korle Bu Teaching Hospital (KBTH). Methods Retrospective review of case notes of patients who had completed treatment for breast cancer at the KBTH within the last 5 years was conducted between April 2011 and March 2012. Subtypes were determined by immunohistochemistry classification based on expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER-2). Result A total of 165 cases contributed to this study. The mean age at diagnosis was 52.5 ± 12.1 years. Tumour size ranged from 0.8 cm to 15 cm with a mean of 4.9 ± 2.8 cm and median of 4 cm. Tumour grade was Grade I 8.3 %, Grade II 60.8 % and Grade III 30.8 %. ER, PR and HER2/neu receptor positivity was 32.1, 25.6 and 25.5 % respectively. Almost half (49.4 %) of the study population had triple negative tumours. Luminal A, luminal B and non-luminal HER2 were 25.6, 12.2, and 12.8 % respectively. No statistically significant association was seen between subtype and tumour size, tumour grade, lymph node status and age at diagnosis. Conclusion Triple negative tumour is the most occurring subtype in the Ghanaian breast cancer population treated at the Korle Bu Teaching Hospital. Lack of association seen between subtypes and their clinical and pathological behaviour could be due to small sample size.
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Affiliation(s)
- Bernard Seshie
- Department of Surgery, Tema General Hospital, Tema, Ghana
| | - Nii Armah Adu-Aryee
- Department of Surgery, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Florence Dedey
- Department of Surgery, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Benedict Calys-Tagoe
- Department of Community Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Joe-Nat Clegg-Lamptey
- Department of Surgery, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
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Mazouni C, Mesnard C, Cloutier AS, Amabile MI, Bentivegna E, Garbay JR, Sarfati B, Leymarie N, Kolb F, Rimareix F. Quilting Sutures Reduces Seroma in Mastectomy. Clin Breast Cancer 2015; 15:289-93. [PMID: 25661806 DOI: 10.1016/j.clbc.2014.12.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 12/31/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Drainage duration and seroma formation occurring after mastectomy with or without axillary surgery lengthens hospitalization and delays adjuvant treatment. The aim of the study was to evaluate the effect of quilting in the prevention of seroma after mastectomy for breast cancer. PATIENTS AND METHODS Eighty-two breast cancer patients about to undergo mastectomy with or without axillary surgery lymphadenectomy were enrolled in the study. We conducted an observational comparison between 41 patients in whom quilting with closed suction drainage was used and 41 patients in whom drainage only was used. RESULTS The mean drained volume was significantly lower in the quilting group compared with the control group on days 1 and 2 (day 1: 107.1 mL vs. 156.5 mL; P = .02; day 2: 108.4 mL vs. 162.8 mL; P = .01). The mean drainage period was shorter in the quilting group (4.6 vs. 5.3 days; P = .046). There were fewer needle aspirations for seroma in the padding group (n = 14, 34.1% vs. n = 24, 58.5%; P = .03). CONCLUSION The use of padding after mastectomy seems to reduce seroma formation, volume drained, and length of drainage time.
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Affiliation(s)
- Chafika Mazouni
- Gustave Roussy, Cancer Campus, Division of Breast and Plastic Surgery, Department of Surgery, Villejuif, France.
| | - Chrystelle Mesnard
- Gustave Roussy, Cancer Campus, Division of Breast and Plastic Surgery, Department of Surgery, Villejuif, France
| | - Alexis-Simon Cloutier
- Gustave Roussy, Cancer Campus, Division of Breast and Plastic Surgery, Department of Surgery, Villejuif, France
| | - Maria-Ida Amabile
- Gustave Roussy, Cancer Campus, Division of Breast and Plastic Surgery, Department of Surgery, Villejuif, France
| | - Enrica Bentivegna
- Gustave Roussy, Cancer Campus, Division of Breast and Plastic Surgery, Department of Surgery, Villejuif, France
| | - Jean-Rémi Garbay
- Gustave Roussy, Cancer Campus, Division of Breast and Plastic Surgery, Department of Surgery, Villejuif, France
| | - Benjamin Sarfati
- Gustave Roussy, Cancer Campus, Division of Breast and Plastic Surgery, Department of Surgery, Villejuif, France
| | - Nicolas Leymarie
- Gustave Roussy, Cancer Campus, Division of Breast and Plastic Surgery, Department of Surgery, Villejuif, France
| | - Frédéric Kolb
- Gustave Roussy, Cancer Campus, Division of Breast and Plastic Surgery, Department of Surgery, Villejuif, France
| | - Françoise Rimareix
- Gustave Roussy, Cancer Campus, Division of Breast and Plastic Surgery, Department of Surgery, Villejuif, France
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15
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Escribà JM, Pareja L, Esteban L, Gálvez J, Melià A, Roca L, Clèries R, Sanz X, Bustins M, Pla MJ, Gil MJ, Borrás JM, Ribes J. Trends in the surgical procedures of women with incident breast cancer in Catalonia, Spain, over a 7-year period (2005-2011). BMC Res Notes 2014; 7:587. [PMID: 25178360 PMCID: PMC4165913 DOI: 10.1186/1756-0500-7-587] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 08/18/2014] [Indexed: 11/25/2022] Open
Abstract
Background Breast cancer (BC) is the most frequent cancer in women, accounting for 28% of all tumors among women in Catalonia (Spain). Mastectomy has been replaced over time by breast-conserving surgery (BCS) although not as rapidly as might be expected. The aim of this study was to assess the evolution of surgical procedures in incident BC cases in Catalonia between 2005 and 2011, and to analyze variations based on patient and hospital characteristics. Methods We processed data from the Catalonian Health Service’s Acute Hospital Discharge database (HDD) using ASEDAT software (Analysis, Selection and Extraction of Tumor Data) to identify all invasive BC incident cases according to the codes 174.0-174.9 of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) that were attended for the one-year periods in 2005, 2008 and 2011. Patients were classified according to surgical procedures (BCS vs mastectomy, and immediate vs delayed reconstruction), and results were compared among periods according to age, stage, comorbidity and hospital level. Results BC surgical procedures were performed in more than 80% of patients. Surgical cases showed a significant increasing trend in the proportion of women aged 50–69 years, more advanced disease stages, higher comorbidity and they were attended in hospitals of less complexity level throughout the study period. Similar pattern was found for patients treated with BCS, which increased significantly from 67.9% in 2005 to 74.0% in 2011. Simple lymph node removal increased significantly (from 48.8% to 71.4% and from 63.6% to 67.8% for 2005 and 2011 in conservative and radical surgery, respectively). A slightly increase in the proportion of mastectomized young women (from 28% in 2005 to 34% in 2011) was detected, due to multiple factors. About 22% of women underwent post-mastectomy breast reconstruction, this being mostly immediate. Conclusions The use of HDD linked to the ASEDAT allowed us to evaluate BC surgical treatment in Catalonia. A consolidating increasing trend of BCS was observed in women aged 50–69 years, which corresponds with the pattern in most European countries. Among the mastectomized patients, immediate breast reconstructions have risen significantly over the period 2005–2011. Electronic supplementary material The online version of this article (doi:10.1186/1756-0500-7-587) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Josep M Escribà
- Catalonian Cancer Registry, Cancer Planning Directorate, Av, Gran Vía 199-203, 08908 L'Hospitalet de Llobregat, Spain.
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Heil J, Rauch G, Szabo AZ, Garcia-Etienne CA, Golatta M, Domschke C, Badiian M, Kern P, Schuetz F, Wallwiener M, Sohn C, Fries H, von Minckwitz G, Schneeweiss A, Rezai M. Breast cancer mastectomy trends between 2006 and 2010: association with magnetic resonance imaging, immediate breast reconstruction, and hospital volume. Ann Surg Oncol 2013; 20:3839-46. [PMID: 23838917 DOI: 10.1245/s10434-013-3097-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Indexed: 11/18/2022]
Abstract
PURPOSE Analysis of mastectomy rates in breast cancer patients diagnosed between 2006 and 2010 in Germany with focus on impact of breast magnetic resonance imaging (MRI), immediate breast reconstruction (IBR) rates, and hospital volume as possible influencing factors of mastectomy rates. METHODS Data of a voluntary monitored benchmarking project were used to evaluate mastectomy trends across time in an unselected cohort of breast cancer patients. We used univariate and multivariate logistic regression analysis to identify predictive factors of mastectomy. RESULTS A total of 142.863 cases were included into the analysis. There was an overall decrease of 5.9% (95% confidence interval 5.1-6.7) in mastectomy trend from 36.5% in 2006 to 30.6% in 2010 (P < 0.0001). Known predictive factors were confirmed. Breast MRI (odds ratio 1.42, 95% confidence interval 1.36-1.47) and small hospitals (<150 cases per year) seem to favor mastectomy. IBR was not associated with mastectomy rates. CONCLUSIONS Mastectomy rates in comparable health systems differ. Performance of preoperative breast MRI and hospital volume seem to be independent influencing factors for mastectomy rates.
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Affiliation(s)
- Joerg Heil
- Breast Unit, University Hospital, University of Heidelberg, Heidelberg, Germany,
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