Breast Cancer Surgery Outcomes Research Articles

Frailty and Malnutrition in Surgical Outcomes of Elderly Breast Cancer Patients.

We evaluate the impact of frailty and malnutrition on breast cancer surgery outcomes in older adults using the ACS 5-factor modified frailty index (MFI) and Global Leadership Initiative on Malnutrition (GLIM) definition. Single institution retrospective review of a prospective database of the older adult (>60 years old) breast cancer surgery patients (2000-2016); cases stratified into groups as per MFI (0-2) and GLIM. Characteristics, 90-day post-op events, and 5-year follow-up data were analyzed to report survival and complication outcomes. Among 436 patients at diagnosis, 213 (48.9%) were >80 years old. 377 (86.5%) were alive at 5 years. 274 (62.8%) had MFI > 0, and 69 (15.8%) had malnutrition. Patients ≥ 80, MFI > 0, and PR-negative tumors had worse 5-year survival. There was no survival difference in patients >80 with/without malnutrition (HR = 1.01, p = 0.971), and there was no difference in mastectomy or lumpectomy (p = 0.560) between patients ≥ 80 or patients younger than 80; however, 94% of immediate reconstruction were in pts < 80. On multivariate regression, complications were associated with age < 80, readmission, MFI > 0, and history of HTN; serious complications were associated with age < 80, readmission, anticoagulation, and not receiving endocrine therapy. MFI showed a significant predictive value for 5-year survival for patients ≥ 80 and should be part of the preoperative evaluation.

Postoperative Outcomes of Breast Cancer Surgery in Tertiary Care Units in Pakistan: A Cross-Sectional Study

Background: Breast cancer is a serious health problem in Pakistan and has high incidence and mortality rate. This paper seeks to compare and contrast surgical care and patient management by analyzing postoperative results of breast cancer operations in tertiary health care centers of Pakistan. Methods: It was a cross-sectional study designed in tertiary care unit of Nishtar hospital Multan where medical records of female breast cancer patients who underwent surgery between January 2024 to June 2024 were analyzed. The demographic data, surgical procedures, postoperative morbidities, hospital stays, and readmission rates data were analyzed using multivariate statistics. Results: In total 300 patients were selected in the study. The rate of developing post-operative complications was 20%, and the most frequent of them were infections (12%). The mean days to recovery including those who were discharged and stayed at home was twenty-one days with a readmission ratio of fifteen percent. Specific factors that were found to have a significant influence on the outcomes consisted of age, comorbidities as well as the surgical method used with the latter having a (p ≤ 0.01). Conclusion: This finding of study stated that the postoperative outcomes of breast cancer surgeries in Pakistani tertiary care units were determined by patients’ characteristics, medical co morbidities, and surgical procedures. Implementing standard of care and making available better surgical modalities can improve the patient care and post-surgical care maybe reduced the rate of further complications among breast cancer patients.

Postoperative Outcomes of Breast Cancer Surgery of Iraqi Patients According To a Comparative Study between Harmonic Focus or Monopolar Electrocautery

Postoperative Outcomes of Breast Cancer Surgery of Iraqi Patients According To a Comparative Study between Harmonic Focus or Monopolar Electrocautery

Association between patient-surgeon race and gender concordance and patient-reported outcomes following breast cancer surgery.

Surgeon- and patient-related factors have been shown to influence patient experiences, quality of life (QoL), and surgical outcomes. We examined the association between patient-surgeon race and gender concordance with QoL after breast reconstruction. We conducted a retrospective cross-sectional analysis of patients who underwent lumpectomy or mastectomy followed by breast reconstruction over a 3-year period. We created the following categories with respect to the race and gender of a patient-surgeon triad: no, intermediate, and perfect concordance. Multivariable regression was used to correlate postoperative global (SF-12) and condition-specific (BREAST-Q) QoL performance with patient-level covariates, gender and race concordance. We identified 375 patients with a mean (± SD) age of 57.6 ± 11.9years, median (IQR) body mass index of 27.5 (24.0, 32.0), and median morbidity burden of 3 (2, 4). The majority of encounters were of intermediate concordance for gender (70%) and race (52%). Compared with gender-discordant triads, intermediate gender concordance was associated with higher SF-Mental scores (β, 2.60; 95% CI, 0.21-4.99, p = 0.003). Perfect race concordance (35% of encounters) was associated with significantly higher adjusted SF-Physical scores (β, 2.14; 95% CI, 0.50-4.22, p = 0.045) than the race-discordant group. There were no significant associations observed between race or gender concordance and BREAST-Q performance. Race-concordant relationships following breast cancer surgery were more likely to have improved global QoL. Perfect gender concordance was not associated with variation in QoL outcomes. Policy-level interventions are needed to facilitate personalized care and optimize breast cancer surgery outcomes.

1016 Assessing the Impact of Axillary Lymph Node Dissection on 30-Day Breast Cancer Surgery Outcomes Across Global Income Settings

Abstract Aim To determine the impact of axillary lymph node dissection (ALND) for breast cancer on 30-day mortality and complication rates across different income settings. Method GlobalSurg3 was a multicentre, international prospective cohort study of patients undergoing surgery for breast cancer. Primary outcomes were death, major complications (Clavien-Dindo III/IV) or surgical site infection (SSI), as defined by the CDC criteria, within 30 days of surgery. Income levels were defined using the World Bank classification. Patient characteristics, presentation and disease factors were analysed across income levels. Multivariate logistic regression models were used to determine the impact of ALND across income group. Results This analysis included 8,406 patients undergoing surgery for breast cancer. Most patients presented with invasive ductal carcinoma (75%). The number of lymph nodes within resection samples were higher in low-lower middle-income countries (mean 13.3, SD 7.8) than in high income countries (mean 4.6, SD 6.3). Mortality and major complication rates were similar across country income groups. However, SSI was elevated in low/lower middle groups (aOR 2.33, 95% CI 1.75–3.12) than in upper middle income (aOR 1.86, 95% CI 1.34–2.59) and high-income groups when ALND was performed. The risk of readmission was also higher. Conclusions Major outcomes following ALND in patients with breast cancer were similar, however the high rate of SSI seen in LMICs is likely to significantly impact patient quality of life and potentially delay adjuvant treatment when available. Higher lymph node clearance within this setting may reduce the risk of recurrence but to the detriment of short-term outcomes.

Patient-Reported Outcome Measures of Breast Cancer Surgery: Evidence Review and Tool Adaptation.

The objective of this scoping review was to review survey instruments for Patient-Reported Outcome Measures (PROMs) and provide recommendations to construct a tool for PROMs specifically for breast cancer patients who have undergone surgery, to overcome the limitations of existing validated tools.A total of 924 articles were screened. Nine articles were selected based on the eligibility criteria. We found that PROMs' data collection along with advancements in the treatment of breast cancer and the resultant improved clinical outcomes, there is a growing appreciation and focus on improving patients' quality of life (QoL). Previous studies have shown that the assessment of PROMs is linked to a positive effect on patients' symptoms of distress, quality of life, acceptance, and satisfaction. Several PROMs tools have been validated for use in cancer survivors. However, it is unclear whether existing tools are appropriate for use in breast cancer patients who have undergone surgical treatment. Hence, we conducted a scoping review.Following a review of the current PROM related to breast cancer and the necessity to build specialized PROMs related to the outcomes of breast cancer surgery, we provide recommendations for the development of a comprehensive tool to overcome the limitations of existing PROMs tools.

Surgical and obstetric outcomes of breast cancer surgery during pregnancy: a nationwide database study in Japan.

Although the incidence of breast cancer during pregnancy is increasing, little is known about short-term outcomes following breast cancer surgery during pregnancy. We aimed to compare the characteristics and outcomes of breast cancer surgery with and without pregnancy, and describe the obstetric outcomes following surgery. The data of 249,257 female patients aged < 60years who underwent breast cancer surgery between July 2010 and March 2020 were analyzed using a nationwide Japanese database; we generated a 1:10 matched-pair cohort (260 and 2597 patients with and without pregnancy, respectively) matched according to age and treatment year. We conducted multivariable analyses to compare surgical procedures and outcomes, adjusting for potential confounders in the matched-pair cohort. Additionally, we described the obstetric outcomes of patients with pregnancy. Patients with pregnancy were more likely to undergo total mastectomy [odds ratio: 1.48 (95% confidence interval: 1.13-1.94)] and axillary dissection [1.62 (1.17-2.24)], but less likely to undergo reconstruction [0.14 (0.07-0.31)], than patients without; however, postoperative complications, postoperative length of stay, and total hospitalization costs did not differ significantly with pregnancy. Additionally, some pregnant patients experienced premature delivery [n = 18 (6.9%)] and miscarriage [n = 4 (1.5%)], and 31 of 101 patients in the third trimester at breast cancer surgery underwent a cesarean section. This study demonstrated significant differences regarding surgical procedures; however, there were no significant differences regarding surgical outcomes between patients who underwent breast cancer surgery with and without pregnancy. Obstetric outcomes following breast cancer surgery were also reported.

Liver transplantation does not increase morbidity or mortality in women undergoing surgery for breast cancer.

Purpose:The incidence of breast cancer following solid organ transplantation is comparable to the age-matched general population. The rate of de novo breast cancer following liver transplantation varies. Furthermore, there is limited information on the management and outcomes of breast cancer in liver transplant recipients. We aim to evaluate the impact of liver transplantation on breast cancer surgery outcomes and compare the outcomes after breast cancer surgery in liver transplant recipient in transplant versus non-transplant centers.Methods:National Inpatient Sample database was accessed to identify liver transplant recipient with breast cancer. Mortality, complications, hospital charges, and total length of stay were evaluated with multivariate logistic regression testing. Weighted multivariate regression models were employed to compare outcomes at transplant and non-transplant centers.Results:Ninety-nine women met inclusion criteria for liver transplantation + breast cancer and were compared against women with breast cancer without liver transplantation (n = 736,527). Liver transplantation + breast cancer had lower performance status as confirmed via higher Elixhauser Comorbidity Index (20.5% vs 10.2%, p < 0001). There were significantly more complications in the liver transplantation cohort when compared to the non-liver transplant recipient (15.0% vs 8.2%, p = 0.012). However, on multivariate analysis, liver transplantation was not an independent risk factor for post-operative complications following breast cancer surgery (odd ratio, 1.223, p = 0.480). Cost associated with breast cancer care was significantly higher in those with liver transplantation (2.621, p < 0.001). Breast conservation surgery in liver transplantation had shorter length of stay as compared to breast cancer alone (odds ratio, 0.568, p = 0.027) in all hospitals.Conclusion:Liver transplantation does not increase short-term mortality when undergoing breast cancer surgery. Although there were significantly more complications in the liver transplantation cohort when compared to the non-liver transplant recipient (15.0% vs 8.2%, p = 0.012), on multivariate analysis, liver transplantation was not an independent risk factor for postoperative complications following breast cancer surgery. Breast cancer management in liver transplant recipient at non-transplant centers incurred higher charges but no difference in complication rate or length of stay when compared to transplant centers.

How Does Patient Socioeconomic Position Affect Breast Cancer Surgical Treatment and Mortality?: A Rapid Review.

BackgroundBreast cancer is the second leading cause of death in women across the world. Despite significant improvements in overall breast cancer survival, disparities still exist. Research shows that socioeconomic position (SEP) plays a strong role in disparities in breast cancer care. Lower SEP can be a predictor of poorer breast cancer health outcomes and treatment received. No recent review has focused on SEP and breast cancer surgery outcomes. We conducted a rapid review assessing how patient SEP affects breast cancer surgical outcomes.MethodsWe developed and ran the search strategy in Ovid MEDLINE in January 2021. We assessed study eligibility using an adapted version of PICOS criteria. We included observational studies that assessed the relationship between SEP and breast cancer surgery treatment, including outcomes like surgery choice, survival, and wait time to surgery. We independently reviewed each article and independently extracted data using a pre-designed form. One reviewer narratively synthesized the data extracted from the included articles.ResultsWe found twelve articles that met inclusion criteria. Eight out of 12 articles showed a difference in breast cancer surgery outcomes based on at least one measure of SEP. Six out of eight articles that collected surgery choice data found that women with lower SEP had lower rates of breast conserving surgery. One out of three articles that collected survival data found that higher SEP had a positive effect on survival. Additionally, one article that collected wait time to surgery data found a significant correlation between lower SEP and longer delays to surgical treatment.ConclusionIn conclusion, our rapid review of SEP and breast cancer surgery outcomes found that there is a relationship between SEP and breast cancer surgery choice. This rapid review did not find enough evidence to see a relationship with overall survival and wait time to surgery.

Early Postoperative Outcomes of Breast Cancer Surgery in a Developing Country.

BackgroundBreast cancer remains the most common cause of cancer related mortality amongst women in Pakistan. Postoperative complications can demoralize the patients and potentially delay adjuvant treatment, leading to adverse outcomes. The overarching aim of the study is to delineate the early postoperative outcomes of breast cancer surgery in Pakistan.Materials and MethodsA retrospective study involving patients who underwent breast cancer surgery from June 2016 to December 2019 was conducted. Perioperative morbidities (30 days) were evaluated and documented. The results obtained were analyzed using the SPSS 23 software (IBM Corporation, Armonk, NY).ResultsA total of 94 patients were included in the study, with the mean age of 50±12.8 years. Breast conserving surgery was performed in 32% (n=31) of the patients, while the remaining 68% (n=63) underwent modified radical mastectomy. The most common complications were seroma formation, flap necrosis and hematoma formation and were observed in 5.3% (n=5), 4.3% (n=4) and 3.2% (n=3) of the patients, respectively.ConclusionEarly postoperative complications can delay the commencement of adjuvant systemic therapy required for further management of breast cancer. These complications elicit equally grave consequences for patients undergoing breast conserving surgery and modified radical mastectomy.

A novel approach to keypoint detection for the aesthetic evaluation of breast cancer surgery outcomes

The implementation of routine breast cancer screening and better treatment strategies made possible to offer to the majority of women the option of breast conservation instead of a mastectomy. The most important aim of breast cancer conservative treatment (BCCT) is to try to optimize aesthetic outcome and implicitly, quality of life (QoL) without jeopardizing local cancer control and overall survival. As a consequence of the impact aesthetic outcome has on QoL, there has been an effort to try to define an optimal tool capable of performing this type of evaluation. Starting from the classical subjective aesthetic evaluation of BCCT (either by the patient herself or by a group of clinicians through questionnaires) to an objective aesthetic evaluation (where machine learning and computer vision methods are employed), leads to less variability and increasing reproducibility of results. Currently, there are some offline software applications available such as BATⒸ and BCCT.core, which perform the assessment based on asymmetry measurements that are computed based on semi-automatically annotated keypoints. In the literature, one can find algorithms that attempt to do the completely automatic keypoint annotation with reasonable success. However, these algorithms are very time-consuming. As the course of research goes more and more into the development of web software applications, these time-consuming tasks are not desirable. In this work, we propose a novel approach to the keypoints detection task treating the problem in part as image segmentation. This novel approach can improve both execution-time and results.

Breast-Contour-Preserving Procedure as a Multidisciplinary Parameter of Esthetic Outcome in Breast Cancer Treatment in The Netherlands

BackgroundThe rate of breast-conserving surgery (BCS) is used as an esthetic outcome parameter, while other treatments contribute also, such as neoadjuvant chemotherapy (NAC) enabling BCS or immediate breast reconstruction (IBR). This study explores these efforts to preserve the patient’s breast contour.Patients and MethodsAll patients who underwent surgery for invasive breast cancer in The Netherlands between January 2011 and December 2015 were selected from the Dutch national breast cancer audit (n = 61,309). The breast-contour-preserving procedures (BCPP) rate was defined as the rate of primary BCS, BCS after NAC, or mastectomy with IBR. BCPP rates were calculated and compared by year of diagnosis, age categories, and individual hospitals.ResultsThe rate of primary BCS remained stable (53%) while the BCPP rate increased from 63% in 2011 to 71% in 2015 due to an increase in patients receiving BCS after NAC and mastectomy with IBR. Primary BCS rates increased with age (from 17% in patients aged < 30 years to 63% in patients aged 60–69 years), while the proportion of patients undergoing mastectomy with IBR decreased from 44% in patients < 30 years to 1% in patients ≥ 70 years. The BCPP rate was similar for all age groups except for patients > 70 years. BCPP rates varied between the different hospitals in The Netherlands, ranging from 47 to 88%.ConclusionsThe chance of preserving the breast contour for patients with breast cancer has increased substantially over recent years. BCPP provides a comprehensive parameter of esthetic outcome of breast cancer surgery.

Predictive model for 5-year mortality after breast cancer surgery in Taiwan residents

BackgroundFew studies of breast cancer surgery outcomes have used longitudinal data for more than 2 years. This study aimed to validate the use of the artificial neural network (ANN) model to predict the 5-year mortality of breast cancer patients after surgery and compare predictive accuracy between the ANN model, multiple logistic regression (MLR) model, and Cox regression model.MethodsThis study compared the MLR, Cox, and ANN models based on clinical data of 3632 breast cancer patients who underwent surgery between 1996 and 2010. An estimation dataset was used to train the model, and a validation dataset was used to evaluate model performance. The sensitivity analysis was also used to assess the relative significance of input variables in the prediction model.ResultsThe ANN model significantly outperformed the MLR and Cox models in predicting 5-year mortality, with higher overall performance indices. The results indicated that the 5-year postoperative mortality of breast cancer patients was significantly associated with age, Charlson comorbidity index (CCI), chemotherapy, radiotherapy, hormone therapy, and breast cancer surgery volumes of hospital and surgeon (all P < 0.05). Breast cancer surgery volume of surgeon was the most influential (sensitive) variable affecting 5-year mortality, followed by breast cancer surgery volume of hospital, age, and CCI.ConclusionsCompared with the conventional MLR and Cox models, the ANN model was more accurate in predicting 5-year mortality of breast cancer patients who underwent surgery. The mortality predictors identified in this study can also be used to educate candidates for breast cancer surgery with respect to the course of recovery and health outcomes.

Breast Cancer Incidence and Predictors of Surgical Outcome: a Nationwide Longitudinal Study in Taiwan

AimsDespite the huge and growing global burden of patients who require breast cancer surgery, high-quality population-based studies of breast cancer trends and outcomes are scarce. The purpose of this study was to explore the incidence of breast cancer and predictors of hospital resource utilisation, mortality and recurrence in a nationwide population of patients who have received surgery. Materials and methodsThis retrospective study analysed trends and outcomes in a Taiwan population of 77 971 patients after breast cancer surgery during 1996–2010. The Cox proportional hazards model was used for multivariate assessment of both mortality and recurrence predictors. ResultsThe data analysis indicated that, during this period, the estimated mean hospital treatment cost and mean length of stay increased by 16.3% and 53.4%, respectively. The estimated mean overall survival time was 138.9 months (standard deviation 0.3 months) and the overall 1, 3, 5 and 10 year survival rates were 97.3, 89.2, 82.2 and 70.1%, respectively. The estimated mean overall recurrence time was 10.8 months (standard deviation 0.2 months) and the overall 1, 3, 5 and 10 year recurrence rates were 0.1, 18.8, 26.6 and 36.0%, respectively. Outcomes were significantly associated with age, Deyo-Charlson comorbidity index score, surgeon seniority, hospital volume, surgeon volume, surgery type, hospital level and baseline comorbidities (P<0.001). ConclusionsAnalyses of these population-based data revealed simultaneous increases in the standard incidence of breast cancer surgery and its associated medical resource utilisation. Notably, healthcare providers and patients should recognise that both patient attributes and hospital attributes may affect breast cancer surgery outcomes.

Outcome of Breast Cancer Surgery in a Selected Specialized Hospital in Dhaka City, Bangladesh

This descriptive type of cross sectional study was conducted to Outcome of breast cancer surgery in a selected specialized hospital in Dhaka city with a sample size of 120. It was found that most of the participants in age group 41-55 years 74.2% followed by >55 years 13.3%, 45000 respectively. Showed that most of the respondents (77.5%) had mental stress and rest of them 22.5% did not. Revealed that most of the respondents (79.2%) breastfeed all the child were all children and rest of them 20.8% were maximum child respectively. Showed that most of the respondents (80%) were thinking have financial problem and rest of them 20% been done not. Revealed that half of the respondents (56.7%) were did not breast biopsy or surgery and rest of them 43.3% were had. A highly significant association between age and socio-demographic of the respondents (P value= 0.000). Showed that there is a significant association between occupation and socio-demographic of the respondents (P value= 0.003).

Burden of preoperative cardiovascular disease risk factors on breast cancer surgery outcomes.

Cardiovascular comorbidities have been studied sporadically in breast cancer surgery. No study has provided a comprehensive assessment of the severity and relative influence of preoperative cardiac risk factors on surgical outcomes. 78,338 breast cancer surgery patients were identified from the 2006 to 2012 National Surgical Quality Improvement Program (NSQIP) database. We estimated the impact of chronic conditions (diabetes, hypertension, obesity, smoking), acute cardiac events (myocardial infarction, congestive heart disease, angina), and past cardiac procedures (cardiac surgery, percutaneous coronary intervention) on 30-day postoperative complications, reoperation, and readmission. Nearly 65% of patients had chronic conditions, <1% had acute events, and 3% had past procedures. The prevalence of outcomes was low: 5% had complications, 4% underwent reoperation, and 4% were readmitted. Over 65% of complications were wound-related. All risk factor categories were associated with complications (ORs from 1.26 to 4.18). Acute events had the strongest effect on overall (OR 3.54, CI 2.55-4.91) and medical (OR 4.18, CI 2.73-6.41) complications. Chronic conditions and past procedures also predicted reoperation and readmission (ORs from 1.57 to 2.68). The odds of all outcomes increased with the number of chronic conditions (ptrend < 0.001). Cardiovascular disease has a significant impact on outcomes even in minimal-risk breast cancer surgery. J. Surg. Oncol. 2016;114:144-149. © 2016 Wiley Periodicals, Inc.

Race/ethnicity and socio-economic differences in breast cancer surgery outcomes

BackgroundThe purpose of this study is to evaluate racial and socio-economic differences in breast cancer surgery treatment, post-surgical complications, hospital length of stay and mortality among hospitalized breast cancer patients. MethodsWe examined the association between race/ethnicity and socio-economic status with treatment and outcomes after surgery among 71,156 women hospitalized with a primary diagnosis of breast cancer using the Nationwide Inpatient Sample database from 2007 to 2011. Multivariable regression models were used to compute estimates, odds ratios and 95% confidence intervals adjusting for age, comorbidities, stage at diagnosis, insurance, and residential region. ResultsBlack women were more likely to receive breast conserving surgery but less likely to receive mastectomies compared with white women. They also experienced significantly longer hospital stays (β=0.31, 95% CI: 0.24, 0.39), post-surgical complications (OR=1.21, 95% CI: 1.04–1.42) and in-hospital mortality (OR=1.26, 95% CI: 1.07–1.50) compared with Whites, after adjusting for other factors including the number of comorbidities and treatment type. ConclusionAmong patients hospitalized for breast cancer, there were racial differences observed in treatment and outcomes. Further studies are needed to fully characterize whether these differences are due to individual, provider level or hospital level factors, and to highlight areas for targeted approaches to eliminate these disparities.

Results of a Surgeon-Directed Quality Improvement Project on Breast Cancer Surgery Outcomes in South-Central Ontario

Gaps in breast cancer (BC) surgical care have been identified. We have completed a surgeon-directed, iterative project to improve the quality of BC surgery in South-Central Ontario. Surgeons performing BC surgery in a single Ontario health region were invited to participate. Interventions included: audit and feedback (A&F) of surgeon-selected quality indicators (QIs), workshops, and tailoring interviews. Workshops and A&F occurred yearly from 2005-2012. QIs included: preoperative imaging; preoperative core biopsy; positive margin rates; specimen orientation labeling; intraoperative specimen radiography of nonpalpable lesions; T1/T2 mastectomy rates; reoperation for positive margins; sentinel lymph node biopsy (SLNB) rates, number of sentinel lymph nodes; and days to receive pathology report. Semistructured tailoring interviews were conducted to identify facilitators and barriers to improved quality. All results were disseminated to all surgeons performing breast surgery in the study region. Over 6 time periods, 1,828 BC charts were reviewed from 12 hospitals (8 community and 4 academic). Twenty-two to 40 participants attended each workshop. Sustained improvement in rates of positive margins, preoperative core biopsies, specimen orientation labeling, and SLNB were seen. Mastectomy rates and overall axillary staging rates did not change, whereas time to receive pathology report increased. The tailoring interviews concerning positive margins, SLNB, and reoperation for positive margins identified facilitators and barriers relevant to surgeons. This surgeon-directed, regional project resulted in meaningful improvement in numerous QIs. There was consistent and sustained participation by surgeons, highlighting the importance of integrating the clinicians in a long-term, iterative quality improvement strategy in BC surgery.

The Effect of Hospital Volume on the Outcome of Breast Cancer Surgery

This study was conducted to investigate whether annual surgical unit caseload affects extent of breast cancer surgery, breast cancer recurrence or breast cancer-specific survival. In a population-based cohort study, 12,604 women diagnosed with breast cancer in Finland during the years 1998-2001 were followed up until the end of year 2008. Surgical units were divided into subgroups: >200, 100-200, 50-99 or <50 breast cancer operations per year. Information on patients, treatment, and follow-up was obtained from two national registries. The analyses were adjusted for age and disease stage. The reliability of the registry information was validated by comparison with information from one hospital area. Cox proportional hazard and logistic regression models were employed in the analyses. Validation of the registry data showed that date of diagnosis, age, stage, extent of surgery, and date and cause of death were reliably recorded in the registers. Information on radiotherapy was obtained by combining different registry data. Data on local and distant recurrences were not reliable enough to allow analyses. Patients in hospitals with smaller caseloads underwent mastectomy more often than those operated in hospitals with higher caseloads (P<0.001). Higher caseloads were also related to improved survival (P=0.031). National registries should include information on both local and distant recurrences in order to provide reliable population-based data for evaluation of treatment results. Centralization of surgery to high-volume centers is supported by a higher incidence of conservative surgery and better survival.

PS2-24: Improving Breast Cancer Surgery Quality Through a Collaborative Surgical Database

Heather Feigelson, PhD, MPH1, Kimberly Bischoff, MSHA1, Erin Bowles, MPH2, Jessica Engel, MSN3, Ted James, MD4, Adedayo Onitilo, MD3, Richard Single, PhD4, Andrew Williams, PhD1, Edward Wagner, MD, MPH5 and Laurence McCahill, MD6 1Kaiser Permanente; 2Group Health Research Institute; 3Marshfield Clinic; 4University of Vermont; 5Group Health; 6Van Andel Research Institute