Abstract
Recently, breast-conserving surgery (BCS) has been replacing mastectomy for breast cancer treatment. The aim of this study was to evaluate the changes in mastectomy and BCS rates and the factors relating to these shifts. A retrospective study in a Brazilian public hospital. Pathological records from female patients who underwent surgery for breast cancer at Hospital das Clínicas, Universidade Federal de Minas Gerais (HC-UFMG), between 1989 and 2008 were reviewed. The mastectomy and BCS rates were calculated. The chi-square test was used to assess factors associated with type of surgical treatment and to compare trends in treatment type over the years. Logistic regression was used for multivariate analysis. From 1989 to 2008, 2050 breast cancer surgical specimens were received in our service, corresponding to 1973 patients; 1324 (64.6%) of them were from mastectomy and 726 (35.4%) from BCS. A shift from mastectomy towards BCS was observed (P < 0.001). In multivariate analysis, earlier year of surgery (P < 0.001), larger tumor size (P < 0.001), having at least one positive axillary lymph node (P < 0.001) and patients' age greater than 68 years (P = 0.007) were predictors of mastectomy. There was a shift from mastectomy towards BCS in our institution over the years. This may reflect consolidation of BCS (plus radiotherapy) as an equivalent treatment to mastectomy in terms of survival and a shift to earlier diagnosis for the disease.
Highlights
Breast cancer is the most common cancer in women worldwide, and the most common cause of cancer deaths in this group.[1]
The aim of this study was to evaluate the changes in mastectomy and breast-conserving surgery (BCS) rates at HC-UFMG from 1989 to 2008, and the factors relating to these shifts
The type of surgery performed shifted from a majority of radical mastectomy in 1989 (37 cases; 82.2%) to a minority in 2008 (75 cases; 46.9%; P < 0.001)
Summary
Breast cancer is the most common cancer in women worldwide, and the most common cause of cancer deaths in this group.[1]. During the first half of the 20th century, Halsted’s radical mastectomy and some variations of the procedure were used to treat the disease.[5,6,7,8] In the 1970s, Fisher’s group in the United States and Veronesi’s group in Italy started comparing the prognoses of patients who had undergone breast-conserving surgery (BCS; wide local excision known as lumpectomy in the United States and quadrantectomy in Italy) and mastectomy for early-stage breast cancer They showed that, when associated with radiotherapy, BCS equaled mastectomy regarding long-term survival.[9,10,11,12,13,14] This led the United States National Institutes of Health to publish a consensus in 1991 stating that BCS could be used when possible.[15] After this consensus had been published, mastectomy rates decreased to less than 50% in some countries.[16,17,18,19,20,21,22]. Among them are the contraindications that are usually taken into consideration for BCS: multicentric tumors, inflammatory breast carcinoma, large tumor in relation to breast size, inability to obtain negative surgical margins, patient’s choice and contraindications for radiotherapy.[23,26,27,28,29,30] Other factors are the surgeon’s preference, histopathological tumor type, positivity of axillary lymph nodes, healthcare availability, findings from imaging studies and genetic abnormalities.[17,19,31,32] not all patients eligible for BCS receive breast conservation, and mastectomy rates vary greatly between cancer centers.[17,22,33,34,35] The Clinical Hospital of the Federal University of Minas Gerais (Hospital das Clínicas, Universidade Federal de Minas Gerais, HC-UFMG), Belo Horizonte, Brazil, is a public general hospital and a reference center for breast cancer treatment
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