Surgical Procedures For Breast Cancer Research Articles

Association of Adjuvant Hormone Therapy Timing With Overall Survival Among Patients With Hormone Receptor–Positive Human Epidermal Growth Factor Receptor-2–Negative Early Breast Cancer Without Chemotherapy

Studies have shown that delayed initiation of surgery and adjuvant chemotherapy is associated with lower rates of breast cancer survival. However, it remains unclear whether delayed initiation of adjuvant hormone therapy (AHT) is associated with survival. To assess the association of time to adjuvant hormone therapy (TTH) with breast cancer survival and evaluate the factors associated with AHT. This cohort study examined data from the National Cancer Database from 2004 through 2014 to assess the association of TTH (stratified as ≤150 and >150 days) with cancer survival. All patients included were diagnosed with stage I to stage III hormone receptor-positive, human epidermal growth factor receptor-2 (ERBB2; formerly HER2)-negative invasive breast cancer and underwent AHT without chemotherapy. Data were analyzed from April 2019 to May 2020. AHT was administered at different time points following surgical procedures for breast cancer treatment. An inverse probability of treatment weighting (IPTW) model was constructed to evaluate overall survival by adjusting for treatment facility, patient demographics, tumor characteristics, and treatment; multivariable logistic regression was conducted to assess factors associated with delayed treatment. A total of 144 103 patients (median [IQR] follow-up, 36.6 months [25.5-49.2 months]; mean [SD] age, 63.7 [11.6] years) were identified, which included 142 916 (99.2%) women, 11 574 (8.0%) Black patients, and 126 013 (87.4%) White patients. Of these, 134 873 patients (93.6%) had a TTH of 150 days or less and 9230 patients (6.4%) had a TTH longer than 150 days. The IPTW-based Cox model demonstrated that patients with delayed AHT (ie, a TTH past 150 days) were associated with decreased survival (hazard ratio [HR], 1.31; 95% CI, 1.26-1.35; P < .001) compared with those receiving the timely treatment (TTH ≤150 days). Several sensitivity analyses (including IPTW with stabilized weight [HR, 1.31; 95% CI, 1.19-1.45; P < .001], propensity score matching [HR, 1.41; 1.13-1.76; P = .002], and propensity score regression adjustment [HR, 1.29; 95% CI, 1.16-1.43; P < .001]) and exploratory subgroup analyses yielded similar trends. Factors associated with delayed AHT included Black racial identity (OR, 1.66; 95% CI, 1.55-1.77), nonprivate insurance (eg, no insurance: OR, 1.46; 95% CI, 1.26-1.70), living in large metropolitan or metropolitan areas (reference vs urban, less urban, or rural: OR, 0.82; 95% CI, 0.76-0.87), treatment in a community hospital (reference vs academic or research: OR, 0.91; 95% CI, 0.84-0.98), Charlson-Deyo Comorbidity Index score 2 or higher (OR, 1.17; 95% CI, 1.04-1.32), poor grade differentiation (OR, 1.42; 95% CI, 1.32-1.53), II and III pathological stage (stage III: OR, 3.13; 95% CI, 2.76-3.54), estrogen receptor-positive (ER+)/progesterone receptor-negative (PR-) or ER-/PR+ (OR, 1.22; 95% CI, 1.13-1.31), receiving breast conservation surgery (reference vs mastectomy: OR, 0.87; 95% CI, 0.79-0.94), and radiotherapy (reference vs no radiotherapy: OR, 0.56; 95% CI, 0.52-0.61). The delay of the initiation of AHT past 150 days was associated with diminished survival in hormone receptor-positive, ERBB2-negative patients with breast cancer who did not receive chemotherapy. Efforts should be made to address factors associated with delayed treatment to improve survival.

Patient-reported outcomes among women with unilateral breast cancer undergoing breast conservation versus single or double mastectomy.

More women with unilateral early stage breast cancer are electing bilateral mastectomy (BM). Many cite anxiety, fear of recurrence, and certain aesthetic desires in their decision-making. Yet conflicting data exist regarding how these factors both inform and are modulated by medical decision-making, especially among women eligible for breast conservation (BCT). This study sought to assess the trajectories of women undergoing various surgical procedures for breast cancer. We performed a prospective longitudinal study of women with unilateral, non-hereditary breast cancer who underwent BCT, unilateral mastectomy (UM), or BM. Women completed surveys before surgery and at 1, 9, and 15months postop. Surveys included questions about treatment preferences, decisional control, the HADS-A anxiety scale, the Fear of Relapse/Recurrence Scale (FRRS), and the BREAST-Q. The Kruskal-Wallis test was used to compare outcomes between BCT, UM, and BM groups at each time point. 203 women were recruited and 177 (87.2%) completed 15-month follow-up. Of these, 101 (57.0%) underwent BCT, 33 (18.6%) underwent UM, and 43 (24.2%) underwent BM. Generalized anxiety and FRRS scores were similar between BCT, UM, and BM groups and declined uniformly after surgery. Although baseline breast satisfaction was similar between groups, at 15months, it was significantly lower in BM patients than in BCT patients. Women who felt "very" confident and "very" informed before surgery had lower anxiety, lower fear of recurrence, better psychosocial well-being (PSWB), and greater breast satisfaction at 15months. While patients who undergo mastectomy have less long-term breast satisfaction, all patients can expect to experience similar improvements in anxiety and PSWB. Efforts should be made to ensure that patients are informed and confident regardless of which surgery is chosen, for this is the greatest predictor of better outcomes.

Changing Trends Concerning Radicality and Appearance in Surgical Procedures for Breast Cancer in Japan

Changing Trends Concerning Radicality and Appearance in Surgical Procedures for Breast Cancer in Japan

Operative and Oncologic Outcomes in 9861 Patients with Operable Breast Cancer: Single-Institution Analysis of Breast Conservation with Oncoplastic Reconstruction.

Oncoplastic reconstruction is an approach that enables patients with locally advanced or adversely located tumors to undergo breast conserving surgery (BCS). The objectives were to identify the use of BCS with oncoplastic reconstruction (BCS+R) and determine the operative and oncologic outcomes compared with other breast surgical procedures for breast cancer. This retrospective cohort study interrogated a single institution's prospectively maintained databases to identify patients who underwent surgery for breast cancer between 2007 and 2014. Surgeries were categorized as BCS, BCS+R, total mastectomy (TM), or TM with immediate reconstruction (TM+R). Demographic and clinicopathologic characteristics and postoperative complications were analyzed. There were 10,607 operations performed for 9861 patients. Median follow-up was 3.4years (range, 0-9.1years). The use of BCS+R had a nearly fourfold increase in the percentage of all breast cancer surgeries during the study period; 75% of patients who underwent BCS+R had a T1 or T2 tumor. There was no difference in the use of BCS+R compared with BCS for any quadrant of the breast except the lower outer quadrant (11.1 vs. 6.8%; p<.0001). BCS+R had a lower rate of seroma formation (13.4 vs. 18%; p=.002) and positive or close margins compared with BCS (5.8 vs. 8.3%; p=.04). There was no difference in overall survival or recurrence-free survival when comparing BCS and BCS+R. Patients undergoing BCS+R are not disadvantaged in terms of complications and short-term (3-year) outcomes compared with BCS patients or patients who underwent TM.

Factors predicting sexual functioning in patients 3 months after surgical procedures for breast cancer: The role of the Sense of Coherence

Women with breast cancer may have significant problems adjusting to the disease and therapy, due to the significant changes in body image and sexuality associated. The aim of this study was to 1) assess sexual functioning 3 months after surgical procedures for breast cancer, and 2) prospectively investigate the usefulness of a Sense of Coherence (SOC) and beauty treatment as predictors of sexual functioning. MethodsOne hundred women with breast cancer were randomly assigned to a group receiving beauty treatments during hospitalization or a control group. SOC subscales were assessed the day before surgery. Psychological distress and body image were assessed on day 6 after surgery and sexual functioning was assessed at three months. ResultsPatients with breast cancer seem to experience significant issues in sexual functioning 3 months after surgery. Half of them declared no sexual activity and 42% had no interest for sex. In terms of Sense of Coherence, only the perception that resources were available to face the disease (i.e. manageability) had a positive influence on sexual functioning. Beauty treatment was also associated, but the most statistically significant predictor of sexual functioning was a younger age. ConclusionThis study provides evidence that coping resources, and especially the perception that resources are available to face disease-related disturbances (i.e. manageability), have a positive influence on sexual functioning. Interventions aimed at improving patient perception of available resources might be useful to improve sexual functioning among patients with breast cancer.

마취 전문서 "마약고(麻藥考)"의 처방과 그 원류에 대한 연구

Objective : This article shows that while Seishu Hanaoka(華岡靑洲) is known to have developed an effective anesthetic formula composed of traditional herbs and performed the world first partial mastectomy under a general anesthesia in 1804, anesthetic formulas very similar to those developed by him were widely recorded and deemed used in Japan and Northeast Asia before his invention. The origin of the formulas will be tracked down to compare with the several formulas broadly administered in the region. Methods : Historical literature analysis was adopted to achieve the objective. 1. Mayaku-ku (麻藥考): this book is the main medical classic by Nakagawa Syutei(中川修亭) that introduces Seishu Hanaoka, his anesthetic formulas and mastectomy. 2. Northeast medical classics: Seuideukhyobang (世醫得效方) in 1337, Uibangryuchui (醫方類聚), Uihui(宜彙) and so on. Result : Herbs such as aconitum and datura were applied as a anesthetic agent early on before the Chinese Yuan dynasty. In Korea as well, some old medical books documented such use of those herbs and relevant formulas. Conclusion : Formulas that counted as invented and employed by Seishu Hanaoka as anesthetics, in fact, had been widely known and used in the region before his era. We should pay due attention to his creativity that combined a western surgical intervention and traditional anesthetic agents and successfully performed a newly introduced surgical practice in Japan. The point is that Hanaoka took note of anesthetic herbs or formulas traditionally inherited in North-east Asian medicine and successfully applied them to the surgical procedures for breast cancer, or mastectomy and mammotomy. This history alerts us to neglected or forgotten potentials of traditional medicine in anesthetic treatment and more.

Meta-analytic comparison of randomized and nonrandomized studies of breast cancer surgery

Randomized controlled trials (RCTs) are thought to provide the most accurate estimation of "true" treatment effect. The relative quality of effect estimates derived from nonrandomized studies (nRCTs) remains unclear, particularly in surgery, where the obstacles to performing high-quality RCTs are compounded. We performed a meta-analysis of effect estimates of RCTs comparing surgical procedures for breast cancer relative to those of corresponding nRCTs. English-language RCTs of breast cancer treatment in human patients published from 2003 to 2008 were identified in MEDLINE, EMBASE and Cochrane databases. We identified nRCTs using the National Library of Medicine's "related articles" function and reference lists. Two reviewers conducted all steps of study selection. We included studies comparing 2 surgical arms for the treatment of breast cancer. Information on treatment efficacy estimates, expressed as relative risk (RR) for outcomes of interest in both the RCTs and nRCTs was extracted. We identified 12 RCTs representing 10 topic/outcome combinations with comparable nRCTs. On visual inspection, 4 of 10 outcomes showed substantial differences in summary RR. The pooled RR estimates for RCTs versus nRCTs differed more than 2-fold in 2 of 10 outcomes and failed to demonstrate consistency of statistical differences in 3 of 10 cases. A statistically significant difference, as assessed by the z score, was not detected for any of the outcomes. Randomized controlled trials comparing surgical procedures for breast cancer may demonstrate clinically relevant differences in effect estimates in 20%-40% of cases relative to those generated by nRCTs, depending on which metric is used.

Assessing the effect of beauty treatments on psychological distress, body image, and coping: a longitudinal study of patients undergoing surgical procedures for breast cancer

Assessing the effect of beauty treatments on psychological distress, body image, and coping: a longitudinal study of patients undergoing surgical procedures for breast cancer

Assessing the effect of beauty treatments on psychological distress, body image, and coping: a longitudinal study of patients undergoing surgical procedures for breast cancer

Women with breast cancer may have significant problems adjusting to disease and therapy due to their association with significant changes in body image and sexuality. The aim of this study was to evaluate the effect of beauty treatments in combination with routine cancer care. One hundred women with breast cancer were randomly assigned to a group receiving beauty treatments during hospitalization or a control group. Psychological distress, body image and coping were assessed twice during the hospitalization period: the day before surgery (baseline) and 6 days later (Time 1). A follow-up assessment was performed three months later (Time 2). Three months after surgery, patients who had received beauty treatments reported higher body-image scores than the control group, but there was no effect in psychological distress. Helplessness/hopelessness increased over time in the control group but not in the group receiving beauty treatments. Overall, this study provides evidence of the usefulness of beauty treatments for breast-cancer patients, in combination with routine care. Although these treatments did not seem to alleviate psychological distress directly, they had a beneficial impact on body image and may strengthen patients' social support and self-esteem.

Short-Term and Long-Term Psychosocial Adjustment and Quality of Life in Women Undergoing Different Surgical Procedures for Breast Cancer

The various surgical procedures for early-stage breast cancer are equivalent in terms of survival. Therefore, other factors, such as the procedures' effect on psychosocial adjustment and quality of life (QOL), take on great importance. The aim of the current study was to prospectively examine the short- and long-term effects of mastectomy with reconstruction, mastectomy without reconstruction, and breast conservation therapy on aspects of psychosocial adjustment and QOL in a sample of 258 women with breast cancer. Participants completed questionnaires before surgery and then again 1, 6, 12, and 24 months after surgery. Questionnaires assessed depressive symptoms, anxiety, body image, sexual functioning, and QOL. Adjustment patterns differed throughout the 2-year period after surgery. Some short-term changes in adjustment (less anxiety, less overall body satisfaction) were similar across surgery groups, whereas others (satisfaction with chest appearance, QOL in physical health domain) were higher for women who had breast conservation therapy. However, women who had mastectomy with reconstruction reported greater satisfaction with their abdominal area. During the long-term follow-up period (6 months to 2 years after surgery), women in all three groups experienced marked improvements in psychosocial adjustment (depressive symptoms, satisfaction with chest appearance, sexual functioning) and QOL in physical and mental health domains. In fact, the level for most variables returned to baseline levels or higher. Overall, the general patterns of psychosocial adjustment and QOL are similar among the three surgery groups.

Health-Related Quality of Life and Patient Satisfaction After Treatment for Breast Cancer in Northern Taiwan

To evaluate health-related quality of life (QoL) and attitudes toward surgical procedures for breast cancer among patients in northern Taiwan. Two hundred twenty posttreatment breast cancer patients completed a QoL survey at two different hospitals in northern Taiwan. Patients (median age, 49 years; range, 32-69 years) had either undergone mastectomy (n = 157) or breast conservation treatment (BCT) (n = 63). The Functional Assessment of Chronic Illness Therapy-Breast questionnaire was used to assess QoL. The patients were also asked about breast reconstruction or use of an artificial breast or not, as well as the decision-making process. There was no significant difference in QoL between patients treated with BCT or mastectomy. Significantly more mastectomy patients had had breast reconstruction or wore an artificial breast (49.7% vs. 3.2%; p < 0.001). Of those who had BCT, 81% would make the same choice again, compared with only 49% of mastectomy patients (p < 0.001). Only 7.6% of patients who made the treatment decision themselves were dissatisfied with their treatment, compared with 25% for whom the decision was made by someone else (p = 0.004). Taiwanese women with breast cancer who had undergone mastectomy did not report a worse QoL than those who received BCT, but they were more likely to be concerned about their resulting body image. Half would have chosen a less extensive procedure if they had it to do over. Women were more likely to be satisfied with the results of their treatment if they had decided themselves.

Quality of life of breast cancer patients and types of surgery for breast cancer — Current status and unresolved issues —

Since standard radical mastectomy was established by Halsted for breast cancer, surgical procedures for breast cancer have been changed according to the results of randomized controlled trials. Breast-conserving treatment is now regarded as a standard local treatment for early breast cancer. More recently, sentinel node biopsy is becoming popular as an alternative procedure to axillary node dissection for nodal staging. These new procedures have been believed to be better in terms of patients' quality of life in comparison with previous surgical procedures without impairing prognosis. Many studies regarding the quality of life (QOL) of patients after such procedures have been reported. Here we review those data, especially of studies comparing quality of life of patients after mastectomy and breast-conserving treatment, and of those after axillary node dissection and sentinel node biopsy. Viewpoints and issues on surgical treatment-related QOL are discussed.

Primary chemotherapy in breast cancer: The beginning of the end or the end of the beginning for the surgical oncologist?

For the last 2000 years surgery has been the primary treatment for patients with breast cancer. During this period, surgical procedures for breast cancer became more extensive and culminated in the radical mastectomy as described by Halstead. Such extensive surgery was fuelled, and perpetuated, by the widespread acceptance of the Halsteadian concept of tumour biology and tumour spread. As a result of this, radical mastectomy dominated surgical practice for breast cancer for almost 100 years [1]. However, with advances in our understanding of tumour biology, these Halsteadian concepts were challenged. As a result, novel, and less extensive, approaches to the surgical treatment of breast cancer were initiated and evaluated in a scientific manner.

A prospective review of the decline of excisional breast biopsy

Background: Although excisional breast biopsy has long been considered the standard for breast cancer diagnosis, core biopsies are now used more frequently. Whether core biopsy can eventually replace excisional biopsy remains unknown. The purpose of this study was to evaluate the relationship between diagnostic excisional and core biopsies relative to surgical treatment procedures. Methods We analyzed our data collected prospectively from 1995 through 2000, which included inpatient and outpatient surgical data, office visits, and radiology biopsy data including stereotactic, mammotome, and ultrasound core biopsies. The Cochran-Armitage trend test was used to assess the shift in diagnostic technique. Results From 1995 through 2000 there were 2,631 core biopsies performed, 2,685 excisional biopsies, 2,881 surgical procedures for breast cancer, and 51,109 office visits. Although the percentage of core biopsies relative to excisional biopsies increased from 31% to 68% ( P <0.001), the percentage of biopsies relative to the number of office visits remained stable at 10% to 11%. The percentage of breast cancer procedures relative to office visits also remained stable at 5% to 6%. Conclusions Our data indicate that core biopsies are being performed more often than excisional biopsies. Nevertheless, one in three biopsies done at our institution is excisional.

SURGICAL TREATMENT OF EARLY BREAST CANCER

This brief review defines the various surgical procedures for breast cancer, which are under dispute by laymen and some surgeons, because of lack of controlled comparative studies and differences in classification of stages of breast cancer. The simplest procedure, tylectomy or lumpectomy, consists of resection of the local lesion only. Simple mastectomy refers to removal of the involved mammary gland and pectoral fascia, perhaps with some easily accessible lymph nodes. Modified radical mastectomy consists of total mastectomy with dissection of the axillary contents. Radical mastectomy, the classical Halsted operation, is removal of breast, subcutaneous tissues, pectoral muscles, axillary contents, followed by skin graft. The extended radical mastectomy also involves resection of parasternal lymph nodes and supraclavicular tissues. For metastases, some physicians prefer irradiation, some chemotherapy and some ovariectomy with hormone therapy. 2 comparative studies cited show no difference in survival rates between radical mastectomy and radical mastectomy with irradiation or between radical mastectomy with irradiation and wide local excision with irradiation.

Adaptation of irradiation techniques to various types of surgical procedures for breast cancer.

Irradiation techniques are described which are adapted according to the types and extent of surgery which have been performed for operable breast cancer. Following a radical or modified radical mastectomy, the technique varies depending on the need to irradiate the axilla. Irradiation to the axilla is unnecessary if the axilla contained operable disease without histologic evidence of extranodal disease, and if the axillary dissection was surgically adequate. The chest wall is irradiated in those patients with a significant risk of recurrent disease in the chest wall. Following a total mastectomy or a wedge excision, the whole axilla must be irradiated. The chest wall or the retained breast is, of course, irradiated.

Some concepts in treatment of breast cancer.

THE INTRODUCTION of new technical concepts in the surgical therapy of cancer of the breast has raised two significant questions, both relevant to the extent of the operation. First, do the sometimes less than radical surgical procedures for breast cancer conducted in a small general hospital give five-year survival rates comparable to those obtained in large medical centers? And second, is there clinical evidence indicating that the scope of the operation should be enlarged for medially situated lesions? The studies of Handley and Thackray 1 have indicated that the internal mammary chain of lymph nodes is involved in a high percentage of malignant growths of the breast. Their studies, as well as those of Urban 2 have produced evidence that lesions in the medial aspect of the breast are more likely to metastasize to the mediastinal nodes than are laterally located lesions which show some preference for spreading to the