ASO Visual Abstract: Decision Regret About Breast Cancer Surgery—The WhySurg Study: Patients Undergoing Bilateral Mastectomy and Breast-Conserving Surgery Found to Have Lowest Levels of Regret

2021 ◽  
Author(s):  
Amanda Deliere ◽  
Deanna Attai ◽  
David Victorson ◽  
Kristine Kuchta ◽  
Catherine Pesce ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Conserving Surgery ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Bilateral Mastectomy ◽  
Decision Regret

scholarly journals Financial Costs and Burden Related to Decisions for Breast Cancer Surgery

2019 ◽  
Vol 15 (8) ◽  
pp. e666-e676 ◽  
Author(s):  
Rachel A. Greenup ◽  
Christel Rushing ◽  
Laura Fish ◽  
Brittany M. Campbell ◽  
Lisa Tolnitch ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Treatment ◽  
Financial Burden ◽  
Breast Conserving Surgery ◽  
Treatment Costs ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Bilateral Mastectomy ◽  
Financial Costs ◽  
The Impact

PURPOSE: Financial toxicity is a well-recognized adverse effect of cancer care, yet little is known about how women consider treatment costs when facing preference-sensitive decisions for breast cancer surgery or how surgical treatment choice affects financial harm. We sought to determine how financial costs and burden relate to decisions for breast cancer surgery. METHODS: Women (≥ 18 years old) with a history of breast cancer were recruited from the Army of Women and Sisters Network to complete an 88-item electronic survey. Descriptive statistics and regression analysis were used to evaluate the impact of costs on surgical decisions and financial harm after breast cancer surgery. RESULTS: A total of 607 women with stage 0 to III breast cancer were included. Most were white (90%), were insured privately (70%) or by Medicare (25%), were college educated (78%), and reported household incomes of more than $74,000 (56%). Forty-three percent underwent breast-conserving surgery, 25% underwent mastectomy, 32% underwent bilateral mastectomy, and 36% underwent breast reconstruction. Twenty-eight percent reported that costs of treatment influenced their surgical decisions, and at incomes of $45,000 per year, costs were prioritized over breast preservation or appearance. Overall, 35% reported financial burden as a result of their cancer treatment, and 78% never discussed costs with their cancer team. When compared with breast-conserving surgery, bilateral mastectomy with or without reconstruction was significantly associated with higher incurred debt, significant to catastrophic financial burden, treatment-related financial hardship, and altered employment. Among the highest incomes, 65% of women were fiscally unprepared, reporting higher-than-expected (26%) treatment costs. CONCLUSION: Cancer treatment costs influenced decisions for breast cancer surgery, and comparably effective surgical treatments differed significantly in their risk of patient-reported financial burden, debt, and impact on employment. Cost transparency may inform preference-sensitive surgical decisions and improve patient-centered care.

Breast Cancer Surgery

2019 ◽  
pp. 144-156
Author(s):  
Peter A. van Dam ◽  
Cary Kaufman ◽  
Carlos Garcia-Etienne ◽  
Marie-Jeanne Vrancken Peeters ◽  
Robert Mansel
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Breast Conserving Surgery ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Breast Diseases ◽  
Breast Cancer Patients ◽  
Breast Conserving Treatment ◽  
Sentinel Node Concept

Abstract: The role of the surgeon managing breast diseases has been the subject of continuous evolution, moving from the cancer-extirpative surgeon to a deeply informed surgical leader, who interacts in a multidisciplinary setting also encompassing tasks for risk assessment, genetic counselling, and new diagnostic approaches. Surgical removal of the tumour remains the cornerstone in treating early stage breast cancer. During the last century, breast cancer surgery became less radical, breast-conserving treatment emerged, and the role of axillary lymphadenectomy changed from a therapeutic procedure into a staging procedure with prognostic implications. Later, the sentinel node concept reduced the need for complete axillary clearance in most cases. Nowadays, thanks to breast-conserving surgery, oncoplastic techniques, and reconstructive procedures, most breast cancer patients can overcome this disease without serious permanent physical mutilation. A multidisciplinary approach, benchmarking, and quality assurance have improved outcomes markedly.

Hiroki Takahashi et al. “Usefulness of endoscopic breast-conserving surgery for breast cancer” Surgery Today in November (2014) 44: 2037–2044

Surgery Today ◽  
2014 ◽  
Vol 45 (8) ◽  
pp. 1071-1072
Author(s):  
S. Singh ◽  
A. A. Agarwal ◽  
K. R. Singh ◽  
A. A. Sonkar ◽  
J. K. Khuswaha ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Conserving Surgery ◽  
Cancer Surgery ◽  
Breast Cancer Surgery

Breast cancer surgery during pregnancy.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1127-1127
Author(s):  
Rakesh Surapaneni ◽  
Jolanta Jozefara ◽  
Karen Hendershott ◽  
Krystal Hunter ◽  
Elyce Cardonick
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Breast Conserving Surgery ◽  
Lymph Node Biopsy ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Breast Cancer Patients ◽  
Node Biopsy ◽  
Significant Difference ◽  
Mastectomy Group

1127 Background: There is limited literature on breast surgery during pregnancy. We present prospective registry data on 88 breast cancer patients who underwent breast cancer surgery during pregnancy. Methods: The Cancer and Pregnancy Registry is a voluntary international registry that prospectively collects the clinical course, treatment, and disease outcome of women diagnosed with cancer during pregnancy and the perinatal and neonatal outcomes of their children. Results: We identified 88 patients who were diagnosed with breast cancer and had surgery while pregnant. 59 patients (67%) underwent Mastectomy while29 patients (32%) underwent breast conserving surgery (BCS). Out of 43 patients who underwent BCS as their first surgery 13 patients (30.23%) required subsequent mastectomy during pregnancy. 15 patients (34.88%) from the BCS group and 4 patients (8.69%) from the Mastectomy group had positive margins. There was no significant difference between patients who underwent mastectomy vs BCS based on Age (34.67 vs 34.72 P: 0.97), gestational age at surgery (14.05 vs 16.06 P: 0.23) or ER positivity (47.5% vs 46.4% P: 0.93). 2 patients had neo-adjuvant chemotherapy. 17 patients (19.31%) had sentinel lymph node biopsy. 37 patients (42%) had a pregnancy complication. There was no difference in the rate of complication based on mastectomy vs BCS(45.8% vs 34.5% P: 0.31). There was only 1 patient (from mastectomy group) that delivered within 2 weeks of surgery. Of the 17 patients (19.3%) with spontaneous preterm delivery, there was no difference between Mastectomy and BCS group (22% vs 13.2% P: 0.41). Of the 25 patients (28.4%) with birth complications, there was no significant difference between mastectomy vs BCS (30.5% vs 24.1% P: 0.53). There was also no difference in mean birth weight between the groups (2598 grams vs 2672.3 grams P: 0.57). Conclusions: The data supports the safety of breast cancer surgery during pregnancy. In addition, there were no identified adverse effects in patients who underwent BCS as opposed to mastectomy. Of note, only 19% of patients underwent sentinel node biopsy which is considered the standard of care in early breast cancer patients regardless of pregnancy status.

Surgical treatment of breast carcinoma after neoadjuvant therapy

2020 ◽  
Vol 99 (4) ◽  
pp. 172-178
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Therapy ◽  
Postoperative Care ◽  
Breast Conserving Surgery ◽  
Lymph Node Biopsy ◽  
Significant Rise ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Select Group

Introduction: Neoadjuvant therapy (NT) applied before breast cancer surgery can lead in favourable cases to regression of the tumor or its total disappearance – pathological complete response (pCR). Due to downstaging after NT, the extent of the surgery can be reduced. pCR represents an important prognostic factor for survival. The aim of this study was to evaluate the effectiveness of NT resulting in pCR on our sample of patients and to assess the frequency of locoregional recurrence (LRR) depending on the extent of the surgery in postoperative care. Methods: This retrospective study was performed on a sample of 96 patients who underwent breast cancer surgery between 2006 and 2018 after previous NT. On the basis of the histological examination after surgery we evaluated the degree of regression and thus also pCR. In postoperative care we followed the patients for any occurrence of LRR in the breast and axilla. Results: pCR (Chevallier 1) was observed in 26 cases – 27.1%. During follow-up in postoperative care, 8 cases of LRR occurred – 8.3% (5.2% after mastectomy and 2.1% after breast-conserving surgery). Mean follow-up was almost 30 months with the median of 26.5 months. Conclusion: With the development of new NT procedures a significant rise in pCR has occurred, predominantly in HER 2+ and triple negative subtypes, thus leading to a decreased incidence of LRR. The number of breast-conserving surgeries with sentinel lymph node biopsy is rising. In a select group of patients breast-conserving surgery is safe and is associated with a low number of LRR events.

Demand for Plastic Surgical Operations after Primary Breast Cancer Surgery

2005 ◽  
Vol 94 (3) ◽  
pp. 211-215 ◽  
Author(s):  
T. Meretoja ◽  
E. Suominen
Keyword(s):  
Breast Cancer ◽  
Breast Reconstruction ◽  
Primary Breast Cancer ◽  
Age Groups ◽  
Breast Conserving Surgery ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Chi Square ◽  
Factors Affecting ◽  
Chi Square Test

Background and Aims: The aim of this study is to evaluate the demand for plastic operations after primary breast cancer surgery. In addition, this study aims to increase knowledge on factors affecting the wish of women for breast reconstruction. Material and Methods: A questionnaire was sent to some 111 patients who had undergone either mastectomy or breast conserving surgery. The response rate was 76 %. The questionnaire consisted of 20 structured questions. The data was analysed statistically using the t test and the chi-square test. Results: 28 % of the mastectomized patients wanted a breast reconstruction. Factors found to affect the patient's wish for reconstruction were age ( p < 0.001) and whether the patient had received radio- ( p < 0.05) or chemotherapy ( p < 0.05). A difference was found between the mastectomy group and the breast conserving surgery group as to satisfaction in the general ( p < 0.05) and the cosmetic ( p < 0.05) outcome of the surgery, as well as patient's expectations regarding the outcome ( p < 0.01). Conclusions: Rather fewer mastectomized patients wanted a reconstruction. The proportion, however, grew significantly larger in the younger age groups. This study also shows that receiving radio- or chemotherapy seems to predict a woman's choice against a reconstruction. Patients who receive radio- or chemotherapy may consider their illness more severe and life-threatening than those not receiving such treatments.

scholarly journals Should Breast Cancer Surgery Be Done in an Outpatient Setting?

2017 ◽  
Vol 77 (08) ◽  
pp. 879-886 ◽  
Author(s):  
Margaret Formago ◽  
Michael Schrauder ◽  
Claudia Rauh ◽  
Carolin Hack ◽  
Sebastian Jud ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Outpatient Surgery ◽  
Day Treatment ◽  
Breast Conserving Surgery ◽  
Outpatient Setting ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Outpatient Basis ◽  
Surgical Interventions ◽  
Outpatient Procedure

Abstract Introduction The care of patients with breast cancer is extremely complex and requires interdisciplinary care in certified facilities. These specialized facilities provide numerous services without being correspondingly remunerated. The question whether breast cancer surgery should be performed in an outpatient setting to reduce costs is increasingly being debated. This study compares inpatient surgical treatment with a model of the same surgery performed on an outpatient basis to examine the potential financial impact. Material and Methods A theoretical model was developed and the DRG fees for surgical interventions to treat primary breast cancer were calculated. A theoretical 1-day DRG was then calculated to permit comparisons with outpatient procedures. The costs of outpatient surgery were calculated based on the remuneration rates of the AOP (Outpatient Surgery) Contract and the EBM (Uniform Assessment Scale) and compared to the costs of the 1-day DRG. Results The DRG fee for both breast-conserving surgery and mastectomy is higher than the fee paid in the context of the EBM system, although the same procedures were carried out in both systems. If a hospital were to carry out breast-conserving surgery as an outpatient procedure, the fee would be € 1313.81; depending on the type of surgery, the hospital would therefore only receive between 39.20% and 52.82% of the DRG fee. This was the case even for a 1-day treatment. Compared to the real DRG fees the difference would be even more striking. Conclusion Carrying out breast cancer surgery as an outpatient procedure would result in a significant shortfall of revenues. Additional services from certified centers, such as the interdisciplinary planning of treatment, psycho-oncological and social-medical care with the involvement of relatives, detailed documentation, etc., which are currently provided without surcharge or adequate remuneration, could no longer be maintained. The quality of processes and excellent results which have been achieved and ultimately the care given by certified facilities would be significantly at risk.

scholarly journals Ultrasound surveillance on detection of nonpalpable supraclavicular recurrence after breast cancer surgery

2020 ◽  
Vol 22 (2) ◽  
pp. 171
Author(s):  
Eun Cho ◽  
Jin Hwa Lee ◽  
Eun Hwa Park ◽  
Kyung Do Byun
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Primary Breast Cancer ◽  
Multivariate Logistic Regression Analysis ◽  
Breast Conserving Surgery ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Breast Cancer Patients ◽  
Asymptomatic Patients ◽  
Internal Mammary

Aims: To evaluate the clinical utility of supraclavicular scanning for locoregional lymph node (LN) assessment in postoperative screening surveillance using ultrasonography (US) in patients who underwent breast cancer surgery.Material and methods: From July 2004 to February 2019, 280 suspicious findings for locoregional recurrence in the lymph node (LRL) on postoperative screening US were detected in 266 asymptomatic patients who underwent breast cancer surgery. Suspicious features of LRL on US included the marked hypoechogenicity, round or irregular shape, eccentric cortical thickening and replacement of the fatty hilum of the LNs. The bilateral breasts, including mastectomy sites, bilateral axillae, internal mammary areas and supraclavicular areas, were included in the scan range of postoperative US.Results: Of 280 LNs with suspicious findings for LRL, LRL of supraclavicular LNs was confirmed in 24 LNs according to cytopathology results. Multivariate logistic regression analysis revealed that higher overall staging of primary breast cancer (odds ratio [OR] 2.361 [95% confidence interval (CI) 1.302–4.282]; p=0.005), higher N staging of primary breast cancer (OR 3.086 [95% CI 1.479–6.441]; p=0.003), older patient age (OR 1.060 [95% CI 1.026–1.095]; p<0.001) and breast-conserving surgery (OR 2.253 [95% CI 1.184–4.289]; p=0.013) were independently associated with LRL of supraclavicular LNs. Tumor size, nuclear grade, histological type, hormonal receptor status of the primary cancer, and bilateral cancer were not associated with LRL (p=0.216, p=0.205, p=0.789, p=0.899, and p=0.900, respectively).Conclusion: Routine supraclavicular scanning in postoperative screening surveillance using US in breast cancer patients with higher staging could be useful for the detection of LRL of supraclavicular LNs. 

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