Differences on breast cancer management and surgical approach in six European breast cancer units

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10737-10737
Author(s):  
A. Celebic ◽  
M. Halaska ◽  
O. Kosovac ◽  
D. Stojiljkovic ◽  
Z. Milovanovic ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Surgical Treatment ◽  
Surgical Approach ◽  
Frozen Section ◽  
Management Decision ◽  
Blue Dye ◽  
Cancer Management ◽  
Comparison Results ◽  
Surgical Evaluation ◽  
The Impact

10737 Background: Paper was aimed to compare differences in pre-operative management, decision on surgery and surgical approach for breast cancer in six European Breast Cancer Units in Italy, France, Czech Republic and Serbia and Montenegro, and to discuss impact of detected differences on outcome of the disease. Methods: The authors of this paper, who have been invited as young visiting/observing/training guests by four prestigious European Breast Cancer Units in Italy and France (National Cancer Institute - Milan, European Institute of Oncology - Milan, Institute Gustave Roussy - Villejuif, Institute Curie - Paris) as fellows of different European and international institutions (EUSOMA, EACR, ESSO, UICC, ESO, FECS, French Government) in the period 2003–2005, tried to detect and compare differences regarding pre-surgical evaluation, decision making and surgical approach for breast cancer as well as to discuss the impact of identified changes on outcome of the disease. The special attention has been directed to inspection of such small details as waiting list for consultation and hospitalisation, way of decision for surgical intervention (individual or oncology meeting/staff), horizontal or oblique incision for mastectomy, duration of hospital stay, sentinel node procedure (blue dye, radioactive tracer or both, one or two-days protocol, imunochistochemistry examinations during frozen section or not), preferred way of breast reconstruction, number of assistants during operation, drainage, preservation of intercostobrachial nerve during axillary surgery, suture, etc. The data were collected according to personal presence in different institutes, observation and asking the questions. Descriptive statistics were used to show the differences among the parameters under comparison. Results: This study which clearly showed a great range of differences, sometimes very significant, in parameters regarding pre-surgical evaluation and surgical treatment of breast cancer. Conclusions: Although being found, and sometimes significant, the observed differences in several parameters regarding pre-operative evaluation and surgical treatment of breast cancer in six European breast cancer units do not have influence to the outcome of the breast cancer. No significant financial relationships to disclose.

scholarly journals Lymphoscintigraphy in breast cancer: a short review about the impact on upper limb after surgical treatment

2008 ◽  
Vol 51 (spe) ◽  
pp. 83-89
Author(s):  
Anke Bergmann ◽  
Juliana Miranda Dutra de Resende ◽  
Sebastião David Santos-Filho ◽  
Marcelo Adeodato Bello ◽  
Juliana Flavia de Oliveira ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Surgical Treatment ◽  
Current Trend ◽  
Surgical Techniques ◽  
Short Review ◽  
Lymphatic Drainage ◽  
Key Words Breast ◽  
Axillary Lymphadenectomy ◽  
The One ◽  
The Impact

Breast cancer is still associated with high mortality rates and one of the most important factors governing long survival is accurate and early diagnosis. In underdeveloped countries, this disease frequently is only detected in advanced stages; however, through mammography, many women have been diagnosed at early stages. In this context, the sentinel lymph node (SLN) technique is associated with less postoperative morbidity compared to axillary lymphadenectomy. Lymphoscintigraphy has emerged as a method for the evaluation of lymphatic drainage chains in various tumours, being both accurate and non invasive. The aim of this work is to present the main aspects which cause controversy about SLN and lymphoscintigraphy and the impact that these procedures have had on lymphedema after surgical treatment for breast cancer. A short review including papers in English, Spanish and Portuguese, available on Lilacs and Medline database, published between January, 2000 and July, 2008 was performed. The key words breast cancer, lymphoscintigraphy, SLN biopsy, lymphedema were used. Various studies have aimed to compare the incidence and prevalence of lymphedema according to the technique used; however, the population subjected to SLN is different from the one with indication for axillary lymphadenectomy regarding staging. Moreover, little is known about long term morbidity since it is a relatively new technique. In conclusion, the development of surgical techniques has permitted to minimize deformities and the current trend is that these techniques be as conservative as possible. Thus, lymphoscintigraphy plays an important role in the identification of SLN, contributing to the prevention and minimization of postoperative complications.

The impact of mammography screening on the surgical treatment of breast cancer

2018 ◽  
Vol 24 (6) ◽  
pp. 1138-1138 ◽  
Author(s):  
Leonardo Ribeiro Soares ◽  
Ruffo Freitas-Junior
Keyword(s):  
Breast Cancer ◽  
Surgical Treatment ◽  
Mammography Screening ◽  
The Impact

A Multidisciplinary Approach to Locoregional Management of the Axilla for Primary Operable Breast Cancer

1997 ◽  
Vol 4 (6) ◽  
pp. 491-499 ◽  
Author(s):  
Benjamin O. Anderson ◽  
Mary M. Austin-Seymour ◽  
Julie R. Gralow ◽  
Roger E. Moe ◽  
David R. Byrd
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Node ◽  
Axillary Dissection ◽  
False Negative ◽  
Cancer Prognosis ◽  
Blue Dye ◽  
Prognostic Information ◽  
Cancer Management ◽  
Axillary Lymphadenectomy

Background Lymph node metastasis is the single most important factor in assessing breast cancer prognosis and planning systemic therapy. However, lymph node dissection portends significant morbidity, with little or no therapeutic benefit if the nodes prove to be negative for cancer. Methods The authors review indications for avoiding axillary dissection, and they analyze the results from lower-level axillary lymphadenectomy together with the morbidity from full axillary dissection. Results Limited level I dissection depends on surgical technique and limits prognostic information. Three approaches have evolved to identify the sentinel node in breast cancer: perilesional breast injection of radiocolloid alone, blue dye alone, or a combination of radiocolloid and blue dye. These techniques provide high diagnostic accuracy, few false-negative results, and less morbidity. Conclusions Knowledge of axillary status is critical to current breast cancer management and cannot be foregone in the preponderance of patients with advanced breast cancer. Results from lymphatic mapping and sentinel node biopsy are highly encouraging.

Thromboembolic events in hospitalized cancer patients: Impact on stay duration and cost for four major cancer localizations.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 186-186
Author(s):  
Florian Scotte ◽  
Alexandre Vainchtock ◽  
Nicolas Martelli ◽  
Isabelle Borget
Keyword(s):  
Breast Cancer ◽  
Prostate Cancer ◽  
Lung Cancer ◽  
Colon Cancer ◽  
Hospital Stay ◽  
Cancer Patients ◽  
Thromboembolic Events ◽  
Cancer Management ◽  
Venous Thromboembolic Events ◽  
The Impact

186 Background: Cancer patients represent an at-risk population for Venous Thromboembolic Events (VTE). Our study aimed to evaluate the impact of VTE on the length and cost of hospital stay in French patients hospitalized for breast cancer (BC), colon cancer (CC), lung cancer (LC) or prostate cancer (PC). Methods: The French national hospital database (PMSI) and the disease-specific ICD-10 codes were used to identify BC, CC, LC or PC patients diagnosed in 2010 who were hospitalized with a VTE during the following two years. We selected stays during which a VTE occurred but was not the main reason of hospitalization (cancer was classified as primary/related diagnosis and VTE as significant associated diagnosis). Those stays were matched and compared to similar stays (same cancer and same reason for hospitalization) without VTE. Costs were calculated using the French official tariffs, from the perspective of the third-party payer. Results: We identified 214 stays for breast cancer during which a VTE occurred and was classified as significant associated diagnosis, 843 stays for colon cancer, 1301 for lung cancer, and 126 for prostate cancer. The comparison between those stays and similar stays without VTE showed significant increase of hospital stay duration in patients experiencing VTE. Median duration rose from 4 to 7 days in BC patients, from 8 to 16 days in CC, from 2 to 9 days in LC and from 6 to 10 days in PC. Consequently, the median expenditure per stay increased by 37% in BC patients with VTE (up to € 5,518), by 61% in CC (up to € 9,878), by 202% in LC (up to € 7,308) and by 22% in PC (up to € 6,200). Conclusions: When occurring during hospitalization, VTE made cancer management much heavier: patients faced prolonged hospital stays whereas healthcare system faced significant additional cost. Better prevention and follow-up measures could reduce this burden, and benefit both patients and hospitals. [Table: see text]

scholarly journals The impact of COVID-19 on and recommendations for breast cancer care: the Singapore experience

2020 ◽  
Vol 27 (9) ◽  
pp. R307-R327 ◽  
Author(s):  
Jack Junjie Chan ◽  
Yirong Sim ◽  
Samuel Guan Wei Ow ◽  
Joline Si Jing Lim ◽  
Grace Kusumawidjaja ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Evidence Base ◽  
Healthcare Sector ◽  
Public Healthcare ◽  
Global Public Health ◽  
Medical Systems ◽  
Outbreak Response ◽  
Cancer Management ◽  
Breast Cancer Management ◽  
The Impact

The ensuing COVID-19 pandemic poses unprecedented and daunting challenges to the routine delivery of oncological and supportive care to patients with breast cancer. Considerations include the infective risk of patients who are inherently immunosuppressed from their malignancy and therapies, long-term oncological outcomes from the treatment decisions undertaken during this extraordinary period, and diverted healthcare resources to support a coordinated whole-of-society outbreak response. In this review, we chronicle the repercussions of the COVID-19 outbreak on breast cancer management in Singapore and describe our approach to triaging and prioritising care of breast tumours. We further propose adaptations to established clinical processes and practices across the different specialties involved in breast oncology, with references to the relevant evidence base or expert consensus guidelines. These recommendations have been developed within the unique context of Singapore’s public healthcare sector. They can serve as a resource to guide breast cancer management for future contingencies in this city-state, while certain elements therein may be extrapolatable to other medical systems during this global public health emergency.

To scan or not to scan: An evaluation of preoperative MRI use in primary breast cancer assessments.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14146-e14146
Author(s):  
Tesia McKenzie ◽  
Davina Matinho ◽  
Olivia Scott ◽  
Arbaz Khan ◽  
Mila Lachica ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Surgical Treatment ◽  
False Positive ◽  
Primary Breast Cancer ◽  
True Positive ◽  
Newly Diagnosed ◽  
Mri Findings ◽  
Positive Rate ◽  
The Impact

e14146 Background: Breast cancer (BC) is the most common invasive cancer in adult females.The role of preoperative MRI in assessing the extent of primary breast cancer remains controversial. This study’s objective is to determine if MRIs performed after the diagnosis of invasive/non-invasive-breast cancer will identify additional breast cancers. We hypothesize that preoperative MRIs will result in the discovery of additional significant lesions, leading to changes in surgical treatment. Methods: A retrospective study of 389 BC patient charts were reviewed, dated from January 2000- July 2019. Files were collected from an office in the Breast Cancer Surgery Department. Information on each patient’s imaging studies, treatment, demographics, surgery, and pathology were collected and stored in anonline cloud system. Summary statistics, including proportions, percentages, and difference of proportion hypothesis tests were utilized to interpret the data. All statistical tests were conducted at a 95% confidence interval. Results: We reviewed the charts of 335 patients that met eligibility criteria. In 221 newly diagnosed cancers, a preoperative MRI was taken before treatment. 127 cancers (57.5%)showed additional finding.In BC patients with additional preoperative MRI findings, we observed 61.4%true positive and 38.6%false positive results. These values are comparable to prior studies.We determined that the treatment plan was altered in 17.6%of all patients who received an MRI and in 30.7%of patients with a true positive MRI finding, which is also consistent with previous literature.A majority of the treatment changes were from Lumpectomy to Mastectomy. Conclusions: Literature on MRI use in BC diagnosis exists; our study differs by focusing on newly diagnosed breast cancers.We discovered 35.3% of preoperative MRIs identified a true additional finding in known breast cancer. In addition, our true positive rate (61.4%) and false positive rate (22.2%) of MRI findings is comparable to those of previous studies. Plans were changed in 30.7% of additional findings supporting the idea that preoperative MRI studies are useful when organizing surgical treatment. Further studies to demonstrate the impact on local recurrence rates and overall survival, may clarify the true role of pre-operative MRI in these cases.

Sentinel Node Mapping for Breast Cancer: The Operative Experience of a Breast Surgeon in a Rural Community

2008 ◽  
Vol 74 (5) ◽  
pp. 423-427
Author(s):  
Flavia E. Davit ◽  
Patrick Gatmaitan ◽  
Gerard Garguilo
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Early Stage ◽  
Frozen Section ◽  
Axillary Lymph ◽  
National Data ◽  
Final Pathology ◽  
Number Of Patients ◽  
The Impact

Sentinel lymph node biopsy has become an accepted procedure for staging the axilla in early stage breast cancer. Our objectives were to review our practice of sentinel lymph node (SLN) mapping in breast cancer, to determine the impact of frozen section (FS) analysis of the SLN on patient management, and to compare our results to national data. We retrospectively reviewed the medical records of our patients with breast cancer who underwent SLN mapping with or without axillary lymph node dissection (ALND) between 1999 and 2006. During this period, 478 patients were treated for breast cancer, with 227 patients undergoing SLN mapping. The SLN was identified in 201 patients, with a positive SLN found in 52 patients (25.9%). There was a discrepancy between the intraoperative analysis (FS/touch prep) and final pathology in 20 patients (11.3%). Nineteen of those patients had a negative FS with positive final pathology. Six of these patients underwent completion ALND. One patient had a false-positive FS with a negative ALND. No axillary recurrences were observed. Eight patients (3.5%) developed postoperative complications. Our practice has been to use intraoperative evaluation of the SLN to reduce the number of patients requiring a secondary ALND. In our study, six patients returned to the operating room for a completion ALND. Our complication rate and axillary recurrence rates were similar to national data.

Persistence of Medical Change at Implementation of Clinical Guidelines on Medical Practice: A Controlled Study in a Cancer Network

2005 ◽  
Vol 23 (19) ◽  
pp. 4414-4423 ◽  
Author(s):  
Isabelle Ray-Coquard ◽  
Thierry Philip ◽  
Guy de Laroche ◽  
Xavier Froger ◽  
Jean-Philippe Suchaud ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Colon Cancer ◽  
Medical Practice ◽  
Controlled Study ◽  
Control Group ◽  
Cancer Management ◽  
Cancer Network ◽  
And Control ◽  
The Impact ◽  
Experimental Group

Purpose A cancer network of general or private hospitals of a French region was started in 1995 for improving quality of care and rationalizing medical prescriptions. The impact of implementing a clinical practice guidelines (CPG) project assessed conformity with guidelines in medical practice; significant changes were observed within the network, whereas no changes were observed in a control region without cancer network. In the present study, we evaluated the persistence of conformity to guidelines through a new medical audit. Patients and Methods In 1999, the hospitals of the previously compared experimental and control groups accepted to reassess the impact of CPG. A controlled transversal study was performed in the experimental group (cancer network) and in the control group (no regional cancer network). In 1996 (first audit) and in 1999 (present audit), all new patients with colon cancer (177 and 200 in experimental group and 118 and 100 in control group, respectively) and early breast cancer (444 and 381 in experimental group and 172 and 204 in control group, respectively) were selected. Results In the experimental group, the compliance of medical decisions with CPG was significantly higher in 1999 than in 1996 for colon cancer (73%; 95% CI, 67% to 79% v 56%; 95% CI, 49% to 63%, respectively; P = .003) and similar for the two periods for breast cancer (36%; 95% CI, 31% to 41% v 40%; 95% CI, 35% to 44%, respectively; P = .24). In the control group, compliance was significantly higher in 1999 than in 1996 for colon cancer (67%; 95% CI, 58% to 76% v 38%; 95% CI, 29% to 47%, respectively; P < .001) and identical for the two periods for breast cancer (4%; 95% CI, 1% to 7% v 7%; 95% CI, 3% to 11%, respectively; P = .19). Conclusion The CPG program for cancer management produced persistent changes in medical practice in our cancer network in terms of conformity with CPG.

How did the COVID crisis affect use of neoadjuvant therapy for patients with breast cancer?

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18708-e18708
Author(s):  
Anees B. Chagpar ◽  
Donald R. Lannin ◽  
Sarah Schellhorn Mougalian ◽  
Elizabeth Rapp Berger ◽  
Cary Philip Gross ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Therapy ◽  
Metastatic Breast ◽  
Practice Setting ◽  
Cancer Management ◽  
Group 3 ◽  
Group 2 ◽  
One Year ◽  
The Impact ◽  
Group 1

e18708 Background: The COVID-19 pandemic has caused shifts in terms of cancer management, but the impact of this has not been well-elucidated in a contemporary cohort of patients in clinical practice in the US. We hypothesized that closure of operating rooms would increase the use of neoadjuvant therapy (NT) during the early pandemic period. Methods: The nationwide Flatiron Health database is a longitudinal electronic health record (EHR)-derived database, comprising de-identified, patient-level structured and unstructured data, curated via technology-enabled abstraction. These data originated from approximately 280 cancer clinics. We compared patients diagnosed with non-metastatic breast cancer during the early pandemic period (March 1 – June 30, 2020; group 1) with those diagnosed in the four month period prior (November 1, 2019 – February 29, 2020; group 2) and those diagnosed during the same period one year earlier (March 1 – June 30, 2019; group 3). Results: There were 174 patients in group 1, 277 in group 2, and 348 in group 3. Overall, 591 (74.1%) were ER/PR+HER2-, 100 (12.6%) were HER2+, and 106 (13.3%) were triple negative (TN). Patients in the three groups were equally likely to be ER/PR+HER2- (75.3% vs. 72.2% vs. 74.9%, p = 0.68), HER2+ (12.1% vs. 14.9% vs. 11%, p = 0.33), TN (12.6% vs. 12.7% vs. 14.2%, p = 0.83) and to be high risk by genomic testing (either Oncotype Dx or Mammaprint; p = 0.72). While there was no difference in the clinical stage (p = 0.36) nor patient age at diagnosis (p = 0.76) across the three groups, patients diagnosed during the early pandemic (group 1) were more likely to receive NT compared to those diagnosed one year earlier (group 3); 28.7% vs 16.4%, p < 0.01 (see table). The use of NT differed between the three groups in the ER/PR+her2- (p < 0.01) and her2+ patients (p = 0.05), but not in the TN patients (p = 0.61). There was no difference in the use of NT overall during the pandemic by geographic state (p = 0.32) nor practice setting (p = 0.23); NT was also similar by geographic state and practice setting when considering the ER/PR+HER2-, HER2+, and TNBC subsets. Conclusions: Despite similar clinicopathologic features as earlier time periods, there was an increased use of NT during the early pandemic when compared to the same period in the prior year. This was seen particularly in the ER/PR+HER2- group, suggesting an increased use of neoadjuvant endocrine therapy.[Table: see text]

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