Extent Of Surgery For Breast Cancer Research Articles

Estimating the Benefit of Preoperative Systemic Therapy to Reduce the Extent of Breast Cancer Surgery: Current Standard and Future Directions.

Once reserved for locally advanced tumors which were deemed inoperable at presentation, preoperative systemic therapy (PST) is nowadays increasingly used to treat early breast cancer. PST allows for in vivo assessment of tumor response, for tailoring of adjuvant systemic therapy and for de-escalation of breast and the axillary surgery. Increased rates of pathological complete response together with more accurate response assessment and surgical planning have led to a significant reduction in surgical morbidity. While surgical assessment remains the standard of care, ongoing studies are evaluating whether surgery can be omitted in patients who achieve a complete pathological response. In this chapter, I will review the impact of PST on surgical de-escalation and the data supporting the safety of this approach.

27IN - Considerations for the Oncologist When Treating Cancer Patients with Germline Mutations

ABSTRACT Cancer therapy is now entering the arena of personalised medicine with therapies targeted to specific tumour or host features. Much of the focus to date has been on somatic genetic changes, such as KRAS mutations in colorectal cancer and BRAF mutations in melanoma, to select for subgroups of patients with the optimal tumour genetic profile for response to targeted therapies. However, the germline genetic profile of patients can also have a major impact on the outcome of cancer therapy by affecting either the chance of response and/or the chance of side effects from treatment. Germline mutations are present in every tumour cell, unlike the genetic heterogeneity of sporadic tumours which are unlikely to have the same crucial mutation in every tumour cell (chronic myeloid leukaemia and gastro-intestinal stromal tumours being notable exceptions), so theoretically increasing the chance of response to a mutation-targeted agent. Examples of germline genetic-driven therapy include the extent of breast cancer surgery at the diagnosis of early breast cancer, the use of poly (ADP-ribose) polymerase inhibitors in BRCA-driven cancers, the use of adjuvant chemotherapy in mismatch repair-deficient colorectal cancer, choice of treatment in early BRCA-driven prostate cancer and the role of smoothened inhibitors in PTCH-associated basal cell carcinomas. In contrast, knowledge of germline genetics can indicate what treatments to avoid where possible, without compromising the chance of cure, such as radiotherapy in people with TP53 or PTCH mutations causing the Li Fraumeni and Gorlin syndromes respectively. Using germline genetics to guide cancer therapy has been limited by the expense, timeliness (or not) of testing and the general appetite (or not) for testing by patients, the medical community and society as a whole. Times are changing; testing is becoming cheaper, faster and society is gradually appreciating the power of genetic information providing safeguards to its use are in place. The challenge is how to integrate germline assessments into routine cancer care across different oncology environments in order to maximise the therapeutic potential of this information. Disclosure: The author has declared no conflicts of interest.

Personalizing extent of breast cancer surgery according to molecular subtypes

The molecular subtype of breast cancer is the major determinant of the type of systemic therapy, but less attention has been paid to the impact of subtype on local therapy outcomes. Presenting features of breast cancer vary with hormone receptor status, with triple negative cancers being significantly less likely than hormone receptor positive cancers to have nodal metastases, and HER2 overexpressing cancers being more likely to be multifocal or multicentric and to have an extensive intraductal component. The risk of local recurrence varies with subtype as well, with triple negative cancers having the highest risk of local recurrence after both breast-conserving therapy and mastectomy, indicating that bigger surgery does not overcome bad biology.

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.