Proportion Of Breast Conserving Surgery Research Articles

Socioeconomic and clinical factors affecting the proportion of breast conserving surgery in Chinese women with breast cancer.

This study investigated the socioeconomic and clinical factors affecting the proportion of breast conserving surgery (BCS) in China, to improve the proportion and success rate of BCS in Chinese breast cancer patients. Six hundred and forty breast cancer patients treated with BCS were compared with 700 selected breast cancer patients (controls) treated with modified radical mastectomy (MRM) in Tianjin Medical University Cancer Institute and Hospital from January 2005 to January 2018. Patients' socioeconomic and clinical factors were collected through telephone interviews or face-to-face interviews. A total of 5,660 BCS patients were enrolled to analyze independent factors affecting initial positive margins. Chi-squared test and multiple logistic regressions were used to examine factors associated with BCS. The locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), and overall survival (OS) were calculated using the Kaplan-Meier method and the survival distribution between BCS and MRM groups was compared by log-rank test. Breast cancer patients who were younger, lived in urban areas, had medical insurance, and higher levels of education and Personal income were more likely to choose BCS. We also observed that patients of Han nationality were more likely to choose BCS. Univariate analysis showed that the frozen section analysis (FSA) positive margin was significantly correlated with tumor distance from the nipple, preoperative magnetic resonance imaging (MRI) examination, T stage, pathological subtype, and lymphovascular invasion (LVI). Multivariate analysis showed the distance from the nipple, T stage, pathological subtype, and LVI, and no preoperative MRI examination were independent predictors of positive resection margins. Multivariate analysis of the correlation between MRI findings and positive resection margins revealed that tumor size, non-mass enhancement (NME), and malignant enhancement surrounding the tumor were independent predictors of positive resection margins. In China, socioeconomic factors largely influence the choice of surgical procedures for breast cancer patients. A gradual reduction in the influence of socioeconomic factors on the proportion of BCS is recommended. Furthermore, preoperative MRI should be encouraged in patients preparing for BCS. Clinicopathological characteristics and MRI findings are significantly associated with a positive resection margin in breast cancer patients.

Abstract PS1-05: Trends in breast-conserving surgery in Mexico after the implementation of a public health insurance system

Abstract Introduction Although temporal trends in breast conserving surgery (BCS) have been described for developed countries like the United States (US), there is a lack of information regarding the uptake of breast conservation in developing regions of the world. In developing countries, the implementation of breast conservation might be hindered by the availability of radiation therapy, lack of training among surgeons, or concerns regarding compliance with follow-up care and surveillance. In 2006, the Mexican government created Seguro Popular, which provided coverage for breast cancer care for all Mexican women, thus potentially mitigating the difficulties with obtaining care after BCS and improving access to multidisciplinary care. We undertook an overview of ten years of breast cancer surgery at our Mexican cancer center following the implementation of Seguro Popular, and explored changes in surgical technique over time. Methods A retrospective cohort analysis was conducted using the National Cancer Institute of Mexico (INCAN) database from 2006 to 2016. All patients with a diagnosis of breast cancer seen during that period were included. Patients who received surgery for breast cancer where then grouped together based on the type of surgery (mastectomy versus BCS). The effect of the year of diagnosis and of clinical stage at the time of presentation was evaluated. Logistic regression was used to model temporal trends in use of BCS over mastectomy for three 3-year periods (2006-2009, 2010-2012, and 2013-2016). Results The patient cohort consisted of 5289 women from the INCAN database, of which 4519 received some form of local surgical treatment. Sixty-one percent (n = 2764) had locally advanced disease (stages IIB-IIIC) at the time of presentation, and a quarter (n = 1156) had ≥60 days between diagnosis and receipt of surgical treatment. Eighty percent of the patients in the entire cohort (n = 3611) were treated with mastectomy, while 20% (n = 908) received BCS. For the 2006-2009 period, out of 1596 total surgeries, 9.9% were BCS (n = 158). The proportion of BCS increased for each of the other two studied periods, being 18.5% for the 2010-2012 period (n = 276/1490), and 33.1% for the 2013-2016 period (n = 474/1433) (p<0.01 for trend). While the increase in BCS was significant for all stages, it was most pronounced for women with early-stage disease (Stages I-IIA), going from 17% in 2006-2009 to 52% in 2013-2016 (p<0.01), than in those with locally-advanced disease (6.5 to 18%, p<0.01). Conclusions In the ten years after the start of the Seguro Popular public insurance program, the proportion of BCS at a Mexican cancer center increased significantly, particularly for women with early-stage disease. The rates seen at INCAN for the period between 2013-2106 resemble those reported by the US National Cancer Database, in which approximately 61% of women with stage I-II breast cancer and 20% of women with stage III disease receive BCS. Potential reasons for the increase in the uptake of BCS include improved access to adjuvant radiation therapy, improved access to systemic treatment, and higher adherence to follow-up care after the start of Seguro Popular, as well as improvements in surgical training. In addition, changes in BCS may also be related to improvements in the implementation of multidisciplinary teams over time, which may lead to a more homogeneous and comprehensive care. Our results show that improving access to care for patients living in developing countries positively impacts the uptake of BCS for women with breast cancer. Citation Format: Enrique Bargalló-Rocha, Nancy Reynoso-Noveron, Jaime Corona, Nereida Esparza-Arias, María Teresa Ramírez-Ugalde, Caros Daniel Robles-Vidal, Robin Shaw-Dulin, Armen Stankov, Rafael Vazquez-Romo, Patricia Villarreal-Colin, Sergio Aguilar-Villanueva, Jaime Hidalgo-Bahena, Milagros Perez-Quintanilla, Fernando U Lara-Medina, Juan Alejandro Torres, Enrique Soto-Perez-de-Celis, Paula Cabrera-Galeana, Alejandro Mohar, Abelardo Meneses-García. Trends in breast-conserving surgery in Mexico after the implementation of a public health insurance system [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-05.

Current Status and Factors Influencing Surgical Options for Breast Cancer in China: A Nationwide Cross-Sectional Survey of 110 Hospitals.

There are limited nationwide data regarding breast cancer surgery in China. The Chinese Anti-Cancer Association's Committee of Breast Cancer Society and the Chinese Society of Breast Surgeons conducted a nationwide survey to examine the use of and barriers associated with surgical options among patients with breast cancer. Surveys were sent via e-mail to the directors of 110 centers that performed at least 200 breast cancer operations in 2017. The electronic questionnaire contained 183 questions and covered six aspects, including demographic information about the hospitals and surgeons, surgical practice, and application of breast reconstruction. The selected hospitals were from 31 provinces or municipalities. The overall proportion of breast-conserving surgery (BCS) was 22%. Local gross domestic product was significantly related to the rate of BCS (p = .046). Sentinel lymph node biopsy was performed routinely in 76% of hospitals. Only 14.5% (16/110) of hospitals used the dual-tracer method, including radioisotopes. For patients with cN0 disease receiving BCS with one or two positive sentinel lymph nodes, 20% (22/110) of hospitals accepted omitting axillary lymph node dissection (ALND). For patients who underwent mastectomy, only 4% (4/110) of hospitals accepted omitting ALND. There was an obvious polarization trend in the proportion of oncoplastic breast-conserving surgery (OPS); 35/110 (32%) performed OPS in fewer than 10% of cases, whereas 36/110 (33%) performed OPS in more than 50% of cases. OPS was more likely to be performed in academic hospitals. Volume displacement was more commonly used than volume replacement (p < .001). Breast reconstruction was routinely performed in 96/110 (87%) of hospitals, 62% of which involved cooperation with the plastic surgery department. Factors influencing breast reconstruction after mastectomy included the establishment of a plastic surgery department, regional economy, and cooperation between the plastic and general surgery departments. Overall, the proportion of breast reconstruction procedures after mastectomy was 10.7%, with 70% being implant-based reconstruction, 17% autologous tissue reconstruction, and 13% a combination. Overall, 22% of the hospitals predominantly performed immediate breast reconstruction. For delayed reconstruction, two-stage implant-based breast reconstruction was the first choice for 46% of centers, whereas 20% of centers chose autologous reconstruction. Among the 96 centers that performed autologous-based reconstruction, 96% performed latissimus dorsi flap reconstruction, 65% performed transverse rectus abdominis musculocutaneous flap reconstruction, and 45% used deep inferior epigastric artery perforator flaps. The results are of great value for promoting the implementation of a consensus on diagnostic and treatment standards, development of guidelines for breast cancer, and training of breast specialists. This study aimed to establish comprehensive baseline data on the status of current breast cancer treatment in China by presenting the statistics on clinical treatments and surgeries, the distribution of clinical stages, and the demographic characteristics of patients. This report is based on a survey conducted by the Chinese Anti-Cancer Association's Committee of Breast Cancer Society and the Chinese Society of Breast Surgeons, which examined the use of breast cancer surgical options in hospitals all over the country and the factors hindering the adoption of procedures and techniques. This study makes a significant contribution to the literature because there are limited nationwide data regarding breast cancer surgery in China.

Factors influencing 3D-MRI diagnosis in preoperative breast cancer patients

607 Background: In breast cancer patients, accurate diagnosis of extent of disease is of great concern for deciding surgical procedure. The purpose of this study was to review imaging diagnosis using 3D-MRI and to evaluate accuracy of 3D-MRI diagnosis and factors influencing 3D-MRI diagnosis retrospectively. Methods: From July 2000, preoperative 3D-MRI was underwent 433 cases of breast cancer patients. Images were obtained from 426 cases (98%). These patients could be divided into four groups according to 3D-MRI images: pattern 1) localized type (243 cases), 2) widely enhanced type A (enhanced area: less than Quadrant [70 cases]) and 3) widely enhanced type B (enhanced area: more than Quadrant [24 cases]) and 4) multi-focal type (89 cases). Diagnosis of intraductal spread was confirmed by pathology and tumor size difference between 3D-MRI and specimens were assessed retrospectively. Results: The rate of histological confirmed intraductal spread was seen in 59% (143/243 cases), 84% (59/70 cases) and 83% (20/24 cases) of patients with 3D-MRI pattern 1), 2), and 3), respectively. From April 2005, the entire specimen was serially step cut and evaluated. Tumor diameter from nipple side to lateral margin was measured by MRI and specimens, tumor size was correlated between MRI and specimens, significantly (n=118, r=07186, p< 0.001). On multivariate analysis, factors influencing accuracy of tumor size in 3D-MRI (less than 1-cm difference) were histological confirmed intraductal spread in specimen (HR=30.64, p<0.001) and preoperative chemotherapy (HR=14.08, p<0.001). Selection for breast-conserving surgery and margin width were based on 3D-MRI images. The proportion of breast-conserving surgery was obtained 95% (231/243 cases), 90% (63/70 cases), 25% (6/24 cases) and 90% (80/89 cases) of patients with 3D-MRI pattern 1), 2), 3), and 4), respectively. Local failures were seen in 2 cases in pattern 1), one case in 3) and one case in 4) (2–90 months, median follow-up of 47 months). Conclusions: These results suggest that MRI will be the useful breast imaging tool in diagnosing intraductal spread and tumor size in breast cancer patients. However, careful management will be needed to do breast-conserving surgery in cases with preoperative systemic therapy and cases expected intraductal spread by other imaging tools. No significant financial relationships to disclose.

Impact of mammographic screening in staging, treatment and prognosis of breast cancer: Early assessment

10537 Background: The use of breast cancer mammographic screening (MS) leads to early detection and has been shown to reduce the mortality rate and to increase the proportion of breast-conserving surgery. The aim of this study is to analyze the impact of mammography in the staging, treatment and prognosis of breast carcinoma. Methods: In 1993, a population-based mammographic screening among women aged from 45 to 70 years was introduced in the community of Valencia. We examined the effects of this MS program by the comparison of two populations. The first one included all the women with screen-detected invasive breast carcinoma between 1993 and 2002 in the community of Valencia. The second one was comprised of all the women with invasive breast carcinoma, diagnosed in the same period, aged 45–70, not attending the MS and treated at H. Clinico of Valencia. Results: Between January, 1993 and December, 2002, 2313 new invasive breast cancer patients were detected by the MS program in the community of Valencia, and 1349 women aged 45–70, not attending de MS were diagnosed with invasive breast carcinoma in H.Clinico of Valencia. The median follow-up period was 45.5 months for the screen-detected breast cancer and 51.9 months for not screen-detected patients. The screen-detected tumors had smaller pathological size (pT1 tumors 70.2% vs 40.5%, p &lt; 0.0001), were more likely to have pathologically confirmed negative nodal status (66.4% vs 52.2%, p &lt; 0.0001) and stage I disease (55.3% vs 26.1%, p &lt; 0.0001). Breast-conserving surgery was performed in 50.4% of patients with screen-detected tumors and in 31.9% of women who had not undergone MS (p &lt; 0.0001). The 5-year estimated survival was 95.5% (SE 0.57) for women with screen-detected breast cancer and 85.5% (SE 1.17) for those with not screen-detected tumors (p &lt; 0.0001). Conclusions: Our data demonstrate a better prognosis in terms of 5-year survival in screen-detected breast cancer patients that may explain why breast carcinoma mortality rates have decreased in recent decades. These patients have also been found to have smaller tumors, a more favorable tumor stage and a higher proportion of breast-conserving surgery. No significant financial relationships to disclose.