Abstract
Breast cancer is the second most prevalent form of cancer in women worldwide, with surgery remaining the standard treatment. The adverse impact of the surgery remains controversial. It has been suggested that systemic factors during the postoperative period may increase the risk of recurrence, specifically surgical site infection (SSI). The aim of this review was to critically appraise current published literature regarding the influence of SSIs, after primary breast cancer surgery, on breast cancer recurrence, and to delve into potential links between these. This systematic review adopted two approaches: to identify the incidence rates and risk factors related to SSI after primary breast cancer surgery; and, secondly, to examine breast cancer recurrence following SSI occurrence. Ninety-nine studies with 484,605 patients were eligible in the SSI-focused searches, and 53 studies with 17,569 patients for recurrence-focused. There was a 13.07% mean incidence of SSI. Six-hundred and thirty-eight Gram-positive and 442 Gram-negative isolates were identified, with methicillin-susceptible Staphylococcus aureus and Escherichia coli most commonly identified. There were 2077 cases of recurrence (11.8%), with 563 cases of local recurrence, 1186 cases of distant and 25 cases which recurred both locally and distantly. Five studies investigated the association between SSI and breast cancer recurrence with three concluding that an association did exist. In conclusion, there is association between SSI and adverse cancer outcomes, but the cellular link between them remains elusive. Confounding factors of retrospective study design, surgery type and SSI definition make results challenging to compare and interpret. A standardized prospective study with appropriate statistical power is justified.
Highlights
A disease that presents in females, breast cancer has been identified as the most commonly diagnosed form of cancer in women globally, with an estimated 2 million reported cases a year [1]
While there is emerging evidence that occurrence of surgical site infection (SSI) may relate to breast cancer recurrence, the influence that these bacterial infections have on breast cancer recurrence rates and the mechanisms required to enable cancer cells to reoccur in the presence of infection, have yet to be determined
Following examination of full texts and application of appropriate exclusion based on the aforementioned criteria, searches that focused on SSI characteristics following primary breast cancer surgery yielded 899 studies, of which 99 [21e60] [61e100] [101e119] were eventually included in this arm of the review
Summary
A disease that presents in females, breast cancer has been identified as the most commonly diagnosed form of cancer in women globally, with an estimated 2 million reported cases a year [1]. Cancer recurrence remains a dominant contributor to breastcancer-related deaths. This is when a subpopulation of primary tumour cells acquire genetic and epigenetic changes and may either persist as dormant or spread systemically, evading treatment, and facilitating relapse months or years later. The 5-year survival rate can drop from 70e80% to less than 30% [3]. The risk of 10year recurrence varies depending on cancer subtype and adjuvant therapy, but has been found to range from 4% to 34% [4]
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