Abstract
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.
Highlights
Breast cancer is the most common cancer in Canadian women and one in eight women are expected to develop breast cancer in their lifetime [1]
In 2012, our institution, the Providence Health Care Breast Centre, reviewed our practice and we found that we met all ACS-NAPBC and EUSOMA Quality Indicators (QIs), we found lower than expected breast-conserving surgery (BCS) rates, at our institution
To identify factors that could further de-escalate early-stage breast cancer surgery, we evaluated the patient and tumour characteristics of the TMPP patient group compared to the TMMN patient group and patients receiving BCS (Table 1)
Summary
Breast cancer is the most common cancer in Canadian women and one in eight women are expected to develop breast cancer in their lifetime [1]. Landmark randomised control clinical trials established the safety of BCS for treatment of Stage I or II breast cancer, finding that BCS plus radiation had equivalent survival compared to TM [2,3]. These findings led to BCS plus radiation being recommended for early-stage breast cancer, assuming that clear margins and an acceptable cosmetic outcome could be obtained [4]. In 2012, our institution, the Providence Health Care Breast Centre, reviewed our practice and we found that we met all ACS-NAPBC and EUSOMA QIs, we found lower than expected BCS rates, at our institution. We hypothesised that mastectomy rates are higher at our institution than European standards due to the number of medically necessary mastectomies
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