Breast surgery

2016 ◽  
Keyword(s):  
Breast Cancer ◽  
Breast Surgery ◽  
The United States ◽  
Breast Cancer Surgery ◽  
Collaborative Group ◽  
High Quality ◽  
Cancer Trials ◽  
Dynamic Time ◽  
Meta Analyses ◽  
Based Medicine

Breast cancer trials started in the 1930s and have made major contributions to the field of evidence-based medicine and the management of breast cancer. In the United States, the National Surgical and Adjuvant Breast Project (NSABP), established in 1957, has been responsible for many pivotal breast cancer trials in breast cancer surgery, radiotherapy, chemotherapy, and hormone therapy. The Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) started in 1985, with the aim of sharing data from high-quality randomized trials worldwide to promote high-quality meta-analyses. Increasingly, breast cancer is being recognized not as one single pathology, but as a disease with a biology and behaviour that is individual to each patient. This chapter discusses trials which have been pivotal in this dynamic time for breast cancer research and which have led the way in personalized therapies for cancer patients.

scholarly journals Breast Cancer Surgery During the COVID-19 Pandemic: An Observational Clinical Study of the Breast Surgery Clinic at Ospedale Policlinico San Martino – Genoa, Italy

In Vivo ◽  
2020 ◽  
Vol 34 (3 suppl) ◽  
pp. 1667-1673 ◽  
Author(s):  
PIERO FREGATTI ◽  
MARCO GIPPONI ◽  
MARIA GIACCHINO ◽  
MARCO SPARAVIGNA ◽  
FEDERICA MURELLI ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Study ◽  
Breast Surgery ◽  
Cancer Surgery ◽  
Breast Cancer Surgery

scholarly journals Is Mastectomy Oncologically Safer than Breast-Conserving Treatment in Early Breast Cancer

Breast Care ◽  
2017 ◽  
Vol 12 (6) ◽  
pp. 385-390 ◽  
Author(s):  
Fabian Riedel ◽  
André Hennigs ◽  
Sarah Hug ◽  
Benedikt Schaefgen ◽  
Christof Sohn ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Surgery ◽  
Breast Conservation ◽  
Breast Cancer Surgery ◽  
Breast Cancer Patients ◽  
Aesthetic Outcome ◽  
Breast Conserving Treatment ◽  
Routine Treatment ◽  
Oncological Safety ◽  
The Individual

Aim: To describe and discuss the evidence for oncological safety of different procedures in oncological breast surgery, i.e. breast-conserving treatment versus mastectomy. Methods: Literature review and discussion. Results: Oncological safety in breast cancer surgery has many dimensions. Breast-conserving treatment has been established as the standard surgical procedure for primary breast cancer and fits to the preferences of most breast cancer patients concerning oncological safety and aesthetic outcome. Conclusions: Breast-conserving treatment is safe. Nonetheless, the preferences of the individual patients in their consideration of breast conservation versus mastectomy should be integrated into routine treatment decisions.

Evidence-based approaches to psychiatry

2017 ◽  
pp. 119-134
Author(s):  
Paul Harrison ◽  
Philip Cowen ◽  
Tom Burns ◽  
Mina Fazel
Keyword(s):  
Patient Experience ◽  
Meta Analysis ◽  
Psychiatric Research ◽  
Evidence Based ◽  
High Quality ◽  
Qualitative Methodologies ◽  
Meta Analyses ◽  
Based Medicine ◽  
Quality Evidence

‘Evidence-based approaches to psychiatry’ describes the application of evidence-based medicine (EBM) to psychiatric practice. The chapter covers the key processes in EBM, including the formulation of a clinically relevant question, the systematic search for high-quality evidence and the meta-analytic synthesis of data. It demonstrates how evidence-based approaches to psychiatry have led to important developments showing quantitative effects of different treatments through advanced meta-analysis of data from randomized trials. This has underpinned the development of clinical guidelines that have the aim of improving the reliability and quality of treatments that patients receive. The chapter also describes how meta-analyses should be critically reviewed, as well as their problems and limitations. Not all relevant questions in psychiatric research are susceptible to the quantitative approach offered by EBM, and the chapter also outlines how qualitative methodologies can play a key role in answering important questions related, for example, to the patient experience.

scholarly journals Predictors of Unemployment After Breast Cancer Surgery: A Systematic Review and Meta-Analysis of Observational Studies

2018 ◽  
Vol 36 (18) ◽  
pp. 1868-1879 ◽  
Author(s):  
Li Wang ◽  
Brian Y. Hong ◽  
Sean A. Kennedy ◽  
Yaping Chang ◽  
Chris J. Hong ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Observational Studies ◽  
Job Demands ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Axillary Lymph ◽  
High Quality ◽  
Moderate Quality ◽  
High Quality Evidence ◽  
Quality Evidence

Purpose Breast cancer surgery is associated with unemployment. Identifying high-risk patients could help inform strategies to promote return to work. We systematically reviewed observational studies to explore factors associated with unemployment after breast cancer surgery. Methods We searched MEDLINE, EMBASE, CINAHL, and PsycINFO to identify studies that explored risk factors for unemployment after breast cancer surgery. When possible, we pooled estimates of association for all independent variables reported by more than one study. Results Twenty-six studies (46,927 patients) reported the association of 127 variables with unemployment after breast cancer surgery. Access to universal health care was associated with higher rates of unemployment (26.6% v 15.4%; test of interaction P = .05). High-quality evidence showed that unemployment after breast cancer surgery was associated with high psychological job demands (odds ratio [OR], 4.26; 95% CI, 2.27 to 7.97), childlessness (OR, 1.30; 95% CI, 1.11 to 1.53), lower education level (OR, 1.15; 95% CI, 1.05 to 1.25), lower income level (OR, 1.46; 95% CI, 1.24 to 1.73), cancer stage II, III or IV (OR, 1.43; 95% CI, 1.13 to 1.82), and mastectomy versus breast-conserving surgery (OR, 1.18; 95% CI, 1.07 to 1.30). Moderate-quality evidence suggested an association with high physical job demands (OR, 2.11; 95%CI, 1.52 to 2.93), African-American ethnicity (OR, 1.89; 95% CI, 1.21 to 2.96), and receipt of chemotherapy (OR, 1.95; 95% CI, 1.36 to 2.79). High-quality evidence demonstrated no significant association with part-time hours, blue-collar work, tumor size, positive lymph nodes, or receipt of radiotherapy or endocrine therapy; moderate-quality evidence suggested no association with age, marital status, or axillary lymph node dissection. Conclusion Addressing high physical and psychological job demands may be important in reducing unemployment after breast cancer surgery.

scholarly journals Audit of Blood Transfusion in Elective Breast Cancer Surgery – Do We Need to Group and Save Pre-Operatively?

2008 ◽  
Vol 90 (6) ◽  
pp. 472-473 ◽  
Author(s):  
Hassan Malik ◽  
Hugh Bishop ◽  
John Winstanley
Keyword(s):  
Breast Cancer ◽  
Blood Transfusion ◽  
Breast Surgery ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Reconstruction Procedure ◽  
Immediate Reconstruction ◽  
Related Data ◽  
Simple Mastectomy ◽  
Operative Assessment

INTRODUCTION Current guidelines on blood ordering in our hospital require all patients undergoing elective breast cancer surgery to have blood grouped, screened and saved as an part of a pre-operative assessment. The aim of this audit was to assess the need for, and cost effectiveness of, this approach in elective breast cancer surgery. PATIENTS AND METHODS Retrospective data collection was undertaken for a 2-year period using the theatre booking system. As a result, 497 consecutive elective breast surgery operations including mastectomies, wide local excisions and breast reconstruction procedures were identified for analysis. Using the hospital blood bank computer system, we established the blood group and save or cross-match status as well as the pre- and postoperative haemoglobin results and blood transfusion related data for each of the patients identified. RESULTS Of the 497 patients, 438 (88.1%) had blood sent for group-and-save. Of the total 497 patients identified, only 19 (3.82%) patients received a blood transfusion. From the 447 patients undergoing simple mastectomy or wide local excisions alone, 9 patients (1.81%) required transfusion. Fifty patients underwent an immediate reconstruction procedure of whom 10 (20%) required a transfusion. CONCLUSIONS This study demonstrates that reconstruction is more likely to be associated with the need for a postoperative transfusion. However, in the context of all breast surgery, blood transfusion is rarely requested. Given this, the time and cost involved in processing a group-and-save pre-operatively is not justified.

scholarly journals Women’s choices for breast cancer surgery in Italy: quality and equity implications

2019 ◽  
Author(s):  
Francesca Ferre ◽  
Chiara Seghieri ◽  
Sabina Nuti
Keyword(s):  
Breast Cancer ◽  
Breast Surgery ◽  
Hospital Performance ◽  
Cancer Surgery ◽  
Patient Choice ◽  
Breast Cancer Surgery ◽  
Surgical Interventions ◽  
Surgery Patient ◽  
National Quality

Abstract Background Equity and quality in healthcare are key goals embraced by universal healthcare systems; however, inequalities in access and unwarranted variations in quality of care are well documented in the Italian healthcare system. To reduce unwarranted variation and improve equal utilization of services at hospital level, national quality standards have been applied for selected clinical procedures including oncological surgery for which there is evidence of a positive relationship between volumes and clinical outcomes. However, high dispersion of surgical interventions across hospitals still exists highlighting the need to understand the determinants behind women’s choice for hospital for breast surgery. Methods We apply mixed logit regression to investigate the determinants, both at patient and provider level, associated with women’s choice of hospital for breast surgery. Patient level non-emergency hospital data are used to model breast cancer surgical choices in Tuscany region, Italy. We considered hospitalizations occurring during 2016. We focused on the effects of travel time and hospital performance for breast cancer treatments (elective surgery) in different patient groups. Hospital quality indicators include structural variables (volumes), measurement of process (timeliness) and quality of surgical procedures as recommended by clinical guidelines (proportion of breast-conservative surgery and execution of the sentinel lymph node biopsy). Results Results reveal that women prefer hospitals nearby, delivering high volumes of interventions with an appropriate surgical approach. Differences in women choice depend on education and age. Highly educated patients travelled further to seek surgical intervention for breast cancer and were likely to select high performing hospitals. Moreover, older women preferred quicker response compared to younger women when awaiting surgical interventions. Conclusions Differences in patient choice highlight equity concerns in access to elective breast cancer surgery. These results could be used to optimize the allocation of resources toward breast cancer units that meet quality and efficacy standards to increase the efficiency and responsiveness of breast cancer care.

scholarly journals Surgical Site Infections in Breast Cancer Patients Undergoing Surgery During the Covid-19 Pandemic. Preliminary Data from an Italian Oncologic Hub.

2021 ◽  
Author(s):  
Sonia Cappelli ◽  
Fabio Pelle ◽  
Marco Clementi ◽  
Maddalena Barba ◽  
Patrizia Vici ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Median Time ◽  
Breast Surgery ◽  
Surgical Site Infections ◽  
Final Analysis ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Breast Cancer Patients ◽  
Intrinsic Nature

Abstract Background: Over the Covid-19 pandemic, the compelling need of containing the virus spread while providing diseased people with adequate assistance has inevitably reflected on treatment priorities, which have been sometimes radically revised according to the intrinsic nature of the institution considered and its role and action within the pandemic context. We report on the experience matured at the Regina Elena National Cancer Institute concerning the effects of the restriction measures adopted during the pandemic on the outcomes of surgical site infections (SSIs) in breast cancer patients (BC-pts) undergoing non-deferrable breast cancer surgery. Methods: Within the frame of an observational study, we compared evidence from two cohorts, namely, the lockdown cohort (LDC) and non-lockdown cohort (NLDC). Patients from the LDC underwent breast cancer surgery between the 15th March 2020 and the 4th May 2020. Breast surgery was performed by the same team and postsurgical controls were performed regularly for a minimum of 12-months. SSIs were defined according to the criteria established by the Center for Disease Control and Prevention. Results: The LDC originally included 79 breast cancer patients, of whom 62 provided data to the final analysis. In the LDC, initially 64 breast cancer patients, only 52 were finally considered. No relevant differences emerged between LDC and NLDC by general characteristics. We observed significant evidence of lower SSIs in the subgroups of patients having undergone skin reducing mastectomy compared with the remaining subgroups (p=0.003). The overall number of surgical site infections was 10 (8.7%), and the median time to their occurrence17.1 days (7- 42). In the NLDC, 7 (13.5) SSIs were identified, with a median time to occurrence of 18.2 days (7-42). In the LDC, 3 (4.8%) SSIs occurred, with a median time to occurrence of 14.3 days (7 to 21). None of these patients was in need of re-hospitalization and there were no delays in adjuvant treatment starting. Conclusions: The restrictive measures issued during the lockdown period seemed to lower the SSI rates in breast cancer patients undergoing non-deferrable breast surgery, although, caution is needed due to the limited sample size.

scholarly journals Impact of COVID-19 pandemic on breast surgery and breast reconstruction in a Japanese university hospital setting.

2020 ◽  
Author(s):  
Dai Shibata ◽  
Takahiko Kawate ◽  
Takako Komiya ◽  
Itaru Nakamura ◽  
Takashi Ishikawa ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Reconstruction ◽  
Chart Review ◽  
Breast Surgery ◽  
Hospital Setting ◽  
Retrospective Chart Review ◽  
University Hospital ◽  
Breast Cancer Surgery ◽  
Short Term ◽  
Japanese University

Abstract The new coronavirus disease (COVID-19) is spreading worldwide. In Japan, the number of people infected has been increasing since March 2020. The COVID-19 pandemic has had a significant impact on hospitals, although Tokyo, Japan did not experience a collapse of the medical system. Patients were triaged and prioritized due to surgical limitations during the pandemic period. The purpose of this study was to determine how patients with breast cancer or breast reconstruction were affected by the COVID-19 pandemic at a university hospital in Tokyo. In this retrospective chart review we investigated how patients were treated, including surgical postponements during three periods: April to July 2020, August to November 2019 (after the Allergan recall), and April to July 2019. More than half of breast surgeries and breast reconstructions had to be postponed during the COVID-19 pandemic, and the number of candidates for surgery was also lower compared to the pre-pandemic periods. Triage of patients with breast cancer did not result in any adverse oncological outcomes for these patients. COVID-19 has had a major impact on breast cancer surgery and breast reconstruction, and there was substantial postponement of surgery. Due to triage and prioritization, no patients experienced disease progression in the short-term period, demonstrating that our strategy was appropriate.

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