scholarly journals De-Escalating Breast Cancer Surgery: Should We Apply Quality Indicators from Other Jurisdictions in Canada?

2021 ◽  
Vol 29 (1) ◽  
pp. 144-154
Author(s):  
Hannah Kapur ◽  
Leo Chen ◽  
Rebecca Warburton ◽  
Jin-Si Pao ◽  
Carol Dingee ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Indicators ◽  
Tumour Size ◽  
Breast Conserving Surgery ◽  
Invasive Cancer ◽  
Breast Cancer Surgery ◽  
Patient Demographics ◽  
Multiple Factors ◽  
Medical Need ◽  
Canadian Population

Quality Indicators (QIs), including the breast-conserving surgery (BCS) rate, were published by the European and American Breast Cancer Societies and this study assesses these in a Canadian population to look for opportunities to de-escalate surgery. A total of 2311 patients having surgery for unilateral, unifocal breast cancer between 2013 and 2017 were identified and BCS QIs calculated. Reasons for mastectomy had been prospectively collected with synoptic operative reporting. Our BCS rate for invasive cancer < 3 cm was 77.1%, invasive cancer < 2 cm was 84.1%, and DCIS < 2 cm was 84.9%. There was no statistically significant change in BCS rates over a five-year period, but there was a reduction in contralateral prophylactic mastectomies (CPM) from 28% in 2013 to 16% in 2017 (p < 0.001). Trend analysis looking at tumour size and medical need for mastectomy indicated that 80% of patients at our centre would be eligible for BCS with tumour cut off of 2.5 cm. Our institution met American but not European QI standards for BCS rates, potentially indicating a difference in patient demographics compared to Europe. Our results support the understanding that BCS rates are influenced by multiple factors and are challenging to compare across jurisdictions. CPM rates may offer a more actionable opportunity to de-escalate surgery for breast cancer.

Breast Cancer Surgery

2019 ◽  
pp. 144-156
Author(s):  
Peter A. van Dam ◽  
Cary Kaufman ◽  
Carlos Garcia-Etienne ◽  
Marie-Jeanne Vrancken Peeters ◽  
Robert Mansel
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Breast Conserving Surgery ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Breast Diseases ◽  
Breast Cancer Patients ◽  
Breast Conserving Treatment ◽  
Sentinel Node Concept

Abstract: The role of the surgeon managing breast diseases has been the subject of continuous evolution, moving from the cancer-extirpative surgeon to a deeply informed surgical leader, who interacts in a multidisciplinary setting also encompassing tasks for risk assessment, genetic counselling, and new diagnostic approaches. Surgical removal of the tumour remains the cornerstone in treating early stage breast cancer. During the last century, breast cancer surgery became less radical, breast-conserving treatment emerged, and the role of axillary lymphadenectomy changed from a therapeutic procedure into a staging procedure with prognostic implications. Later, the sentinel node concept reduced the need for complete axillary clearance in most cases. Nowadays, thanks to breast-conserving surgery, oncoplastic techniques, and reconstructive procedures, most breast cancer patients can overcome this disease without serious permanent physical mutilation. A multidisciplinary approach, benchmarking, and quality assurance have improved outcomes markedly.

scholarly journals Financial Costs and Burden Related to Decisions for Breast Cancer Surgery

2019 ◽  
Vol 15 (8) ◽  
pp. e666-e676 ◽  
Author(s):  
Rachel A. Greenup ◽  
Christel Rushing ◽  
Laura Fish ◽  
Brittany M. Campbell ◽  
Lisa Tolnitch ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Treatment ◽  
Financial Burden ◽  
Breast Conserving Surgery ◽  
Treatment Costs ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Bilateral Mastectomy ◽  
Financial Costs ◽  
The Impact

PURPOSE: Financial toxicity is a well-recognized adverse effect of cancer care, yet little is known about how women consider treatment costs when facing preference-sensitive decisions for breast cancer surgery or how surgical treatment choice affects financial harm. We sought to determine how financial costs and burden relate to decisions for breast cancer surgery. METHODS: Women (≥ 18 years old) with a history of breast cancer were recruited from the Army of Women and Sisters Network to complete an 88-item electronic survey. Descriptive statistics and regression analysis were used to evaluate the impact of costs on surgical decisions and financial harm after breast cancer surgery. RESULTS: A total of 607 women with stage 0 to III breast cancer were included. Most were white (90%), were insured privately (70%) or by Medicare (25%), were college educated (78%), and reported household incomes of more than $74,000 (56%). Forty-three percent underwent breast-conserving surgery, 25% underwent mastectomy, 32% underwent bilateral mastectomy, and 36% underwent breast reconstruction. Twenty-eight percent reported that costs of treatment influenced their surgical decisions, and at incomes of $45,000 per year, costs were prioritized over breast preservation or appearance. Overall, 35% reported financial burden as a result of their cancer treatment, and 78% never discussed costs with their cancer team. When compared with breast-conserving surgery, bilateral mastectomy with or without reconstruction was significantly associated with higher incurred debt, significant to catastrophic financial burden, treatment-related financial hardship, and altered employment. Among the highest incomes, 65% of women were fiscally unprepared, reporting higher-than-expected (26%) treatment costs. CONCLUSION: Cancer treatment costs influenced decisions for breast cancer surgery, and comparably effective surgical treatments differed significantly in their risk of patient-reported financial burden, debt, and impact on employment. Cost transparency may inform preference-sensitive surgical decisions and improve patient-centered care.

Hiroki Takahashi et al. “Usefulness of endoscopic breast-conserving surgery for breast cancer” Surgery Today in November (2014) 44: 2037–2044

Surgery Today ◽  
2014 ◽  
Vol 45 (8) ◽  
pp. 1071-1072
Author(s):  
S. Singh ◽  
A. A. Agarwal ◽  
K. R. Singh ◽  
A. A. Sonkar ◽  
J. K. Khuswaha ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Conserving Surgery ◽  
Cancer Surgery ◽  
Breast Cancer Surgery

scholarly journals Association between underestimation of tumour size by imaging and incomplete excision in breast-conserving surgery for breast cancer

2016 ◽  
Vol 103 (7) ◽  
pp. 830-838 ◽  
Author(s):  
J. M. Dixon ◽  
C. Newlands ◽  
C. Dodds ◽  
J. Thomas ◽  
L. J. Williams ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Tumour Size ◽  
Breast Conserving Surgery ◽  
Incomplete Excision

scholarly journals THE PSYCHOLOGICAL IMPACT OF BREAST-CONSERVING SURGERY VERSUS MASTECTOMY IN EGYPTIAN FEMALE PATIENTS

2021 ◽  
Vol 7 (4) ◽  
pp. 124-133
Author(s):  
Ahmed Abdelatif ◽  
Galal Abounaggah ◽  
Mohamed Elmesery ◽  
Mohamed Asal ◽  
Moataz Eweda
Keyword(s):  
Breast Cancer ◽  
Psychological Impact ◽  
Radical Mastectomy ◽  
Conservative Surgery ◽  
Breast Conserving Surgery ◽  
Breast Cancer Surgery ◽  
Sexual Life ◽  
Surgical Decision ◽  
Factors Affecting ◽  
Loss Of Appetite

The previous research on breast cancer's psychological impact was based on its effects on shape, with breast removal, and the subsequent effect on sexual attractiveness. Several changes that affect life behavior after breast cancer surgery including insomnia, difficulty returning to usual activities and work, nightmares and loss of appetite. These manifestations may be due to depression but they are only considered abnormal if they persist after the period of physical recovery from surgery. We conducted a study to assess the effects of the surgical decision and psychological impact of this decision on Egyptian females with breast cancer. Most patients were subjected to a questionnaire including all environmental and clinical factors affecting the surgical decision either mastectomy or breast-conserving surgery. As a conclusion we can say that breast conservative surgery is better accepted psychologically by patients than modified radical mastectomy as it did not affect sexual life, cosmetic appearance, mood, self-satisfaction, and quality of life.

Breast cancer surgery during pregnancy.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1127-1127
Author(s):  
Rakesh Surapaneni ◽  
Jolanta Jozefara ◽  
Karen Hendershott ◽  
Krystal Hunter ◽  
Elyce Cardonick
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Breast Conserving Surgery ◽  
Lymph Node Biopsy ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Breast Cancer Patients ◽  
Node Biopsy ◽  
Significant Difference ◽  
Mastectomy Group

1127 Background: There is limited literature on breast surgery during pregnancy. We present prospective registry data on 88 breast cancer patients who underwent breast cancer surgery during pregnancy. Methods: The Cancer and Pregnancy Registry is a voluntary international registry that prospectively collects the clinical course, treatment, and disease outcome of women diagnosed with cancer during pregnancy and the perinatal and neonatal outcomes of their children. Results: We identified 88 patients who were diagnosed with breast cancer and had surgery while pregnant. 59 patients (67%) underwent Mastectomy while29 patients (32%) underwent breast conserving surgery (BCS). Out of 43 patients who underwent BCS as their first surgery 13 patients (30.23%) required subsequent mastectomy during pregnancy. 15 patients (34.88%) from the BCS group and 4 patients (8.69%) from the Mastectomy group had positive margins. There was no significant difference between patients who underwent mastectomy vs BCS based on Age (34.67 vs 34.72 P: 0.97), gestational age at surgery (14.05 vs 16.06 P: 0.23) or ER positivity (47.5% vs 46.4% P: 0.93). 2 patients had neo-adjuvant chemotherapy. 17 patients (19.31%) had sentinel lymph node biopsy. 37 patients (42%) had a pregnancy complication. There was no difference in the rate of complication based on mastectomy vs BCS(45.8% vs 34.5% P: 0.31). There was only 1 patient (from mastectomy group) that delivered within 2 weeks of surgery. Of the 17 patients (19.3%) with spontaneous preterm delivery, there was no difference between Mastectomy and BCS group (22% vs 13.2% P: 0.41). Of the 25 patients (28.4%) with birth complications, there was no significant difference between mastectomy vs BCS (30.5% vs 24.1% P: 0.53). There was also no difference in mean birth weight between the groups (2598 grams vs 2672.3 grams P: 0.57). Conclusions: The data supports the safety of breast cancer surgery during pregnancy. In addition, there were no identified adverse effects in patients who underwent BCS as opposed to mastectomy. Of note, only 19% of patients underwent sentinel node biopsy which is considered the standard of care in early breast cancer patients regardless of pregnancy status.

13. A Navigated Intelligent Knife for Breast Cancer Surgery

2018 ◽  
Author(s):  
Mark Asselin
Keyword(s):  
Breast Cancer ◽  
Tracking System ◽  
Treatment Options ◽  
Three Dimensional ◽  
Positive Margin ◽  
Breast Conserving Surgery ◽  
Breast Cancer Surgery ◽  
Feasibility Trial ◽  
Clinical Safety ◽  
Surgical Smoke

When a woman is diagnosed with breast cancer, several treatment options are considered including breast conserving surgery. In this type of surgery, the goal is to completely remove the cancer while leaving as much healthy breast tissue as possible. This is a clinical judgement of high consequence since resecting less tissue is cosmetically appealing but increases the chances of leaving cancer cells behind, known as a positive margin. Conventionally, this operation is performed with an electrocautery – imagine it as an electronic knife – which seals tissue as it cuts and produces small amounts of surgical smoke in the process. In most operating rooms today this smoke is treated as a by product, and it is discarded with no further consideration. But this smoke is rich with useful information; it contains traces of the molecules the knife passed through when the smoke was generated. The intelligent knife (iKnife) analyzes this smoke to determine the pathology of tissue the surgeon’s knife has passed through – whether the tissue is cancerous or not. We have coupled the iKnife with an electromagnetic position tracking system to create a three dimensional spatially resolved malignancy map showing where the surgeon’s knife has encountered cancerous tissue. We have developed a functional prototype and have approval for a first clinical safety and feasibility trial. We hope the spatial map will help surgeons to successfully remove the entire malignancy with the smallest amount of healthy tissue while maintaining negative margins – a successful surgical outcome for the patient.

scholarly journals Invasive Cancer Confined to the Nipple of the Conserved Breast: A Case Report

2020 ◽  
Vol 13 (3) ◽  
pp. 1125-1130
Author(s):  
Miyuki Kitahara ◽  
Yasuo Hozumi ◽  
Naoto Takeuchi ◽  
Satoko Ichinohe ◽  
Mitsuki Machinaga ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Local Recurrence ◽  
Ductal Carcinoma ◽  
Breast Conserving Surgery ◽  
Lymph Node Biopsy ◽  
Invasive Cancer ◽  
Breast Cancer Patients ◽  
Skin Changes ◽  
True Recurrence ◽  
The Right

Invasive breast cancer deriving from the milk duct and lobule that develops in the nipple is extremely rare, except in Paget’s disease and skin cancer. This is the second reported case of the development of invasive cancer confined to the nipple after breast-conserving surgery. A 69-year-old woman visited our department due to redness, swelling, and bloody discharge of the right nipple in the last month. A needle biopsy was suggestive of invasive ductal carcinoma; we performed a removal surgery of the right residual breast tissue and a second sentinel lymph node biopsy. She underwent these procedures 10 years previously as well. Thus, we diagnosed the present lesion as a local recurrence, but it was unknown whether the lesion was a true recurrence or second cancer, namely, metachronal ipsilateral breast cancer. The present case helps promote awareness that invasive cancer rarely develops in the nipple after conserving surgery. Patients should be encouraged to visit a medical facility if experiencing skin changes and swelling of the nipple. Additionally, breast cancer patients must be carefully selected for breast-conserving surgery; failure to do so may later result in nipple-specific local recurrence.

Encounter Decision Aids Can Prompt Breast Cancer Surgery Cost Discussions: Analysis of Recorded Consultations

2019 ◽  
Vol 40 (1) ◽  
pp. 62-71 ◽  
Author(s):  
Mary C. Politi ◽  
Renata W. Yen ◽  
Glyn Elwyn ◽  
Natasha Kurien ◽  
Sophie G. Czerwinski ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Financial Distress ◽  
Decision Aids ◽  
Breast Conserving Surgery ◽  
Breast Cancer Surgery ◽  
Cost Information ◽  
Clinician Training ◽  
Group 2 ◽  
Additional Support ◽  
The Cost

Background. Patients frequently worry about care costs, but clinicians seldom address the topic. Cost information is not typically included in patient decision aids (DAs). We examined whether including cost information in an encounter DA, with clinician training, influenced cost conversations. Method. As part of a larger trial, 14 surgeons from 4 cancer centers were randomized to 1 of 3 interventions: (1) Picture Option Grid DA that included a prompt to discuss relative treatment costs, hereafter called “cost prompt group”; (2) a text-only Option Grid DA that did not include cost information; (3) usual care. Groups 2 and 3 hereafter are referred to as “non-cost prompt groups.” Adult (18+) female patients, with stages I-IIIA breast cancer, eligible for both breast-conserving surgery and mastectomy were included. We gave surgeons feedback about adherence to the study protocol at 3, 6, and 12-months. We adapted a checklist to code the content of the audio-recorded clinical encounters. Results. 424/622 (68%) patients consented; 311 (73%) were eligible and successfully recorded (143 in the cost prompt group, 168 in the non-cost prompt groups). Costs were discussed in 132/311 (42.4%) encounters, and occurred more often in the cost prompt versus non-cost prompt groups (66.7% versus 33.3%; p<.001). Surgeons initiated the cost discussion in 86.4% of encounters in the cost prompt group vs. 34.1% in the non-cost prompt groups (p<0.001). In the non-cost prompt groups, insurance or employment questions led patients to ask about costs. Cost discussions lasted about 34 seconds when present and had sparse comparative details. Conclusions. Encounter DAs containing cost information trigger cost discussions. Additional support should help clinicians improve the quality of cost discussions and address financial distress.

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