Breast Conservative Surgery for Breast Cancer: Indian Surgeon’s Preferences and Factors Influencing Them

Abstract Background: It is well established that disease-free survival and overall survival after breast conservation surgery (BCS) followed by radiotherapy are equivalent to that after mastectomy. However, in Asian countries, the rate of BCS continues to remain low. The cause may be multifactorial including the patient’s choice, availability and accessibility of infrastructure and surgeon’s choice. We aimed to elucidate the Indian surgeons’ perspective while choosing between BCS and mastectomy, in women oncologically eligible for BCS. Methods: We conducted a survey-based cross-sectional study over 3 weeks between January-February 2021. Indian surgeons with general surgical or specialised onco-surgical training, who consented to participate were included in the study. Multinomial logistic regression was performed to assess the effect of study variables on offering mastectomy or BCS to an eligible patient.Results: A total of 347 responses were included. The mean age of the participants was 43(11) years. 63% of the surgeons were in the 25-44 years age group with the majority (80%) being males. 66.4% of surgeons ‘almost always’ offered BCS to oncologically eligible patients. Surgeons who had undergone specialised training in oncosurgery or breast conservation surgery were 35 times more likely to offer BCS (p<0.01). Surgeons working in hospitals with in-house radiation oncology facilities were 9 times more likely to offer BCS (p<0.05). Surgeons’ years of practice, age, sex and hospital setting did not influence the surgery offered.Conclusion: Our study found that two-thirds of Indian surgeons preferred BCS over mastectomy. Lack of radiotherapy facilities and specialised surgical training were deterrents to offering BCS to eligible women.

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Breast Conservation Surgery versus Modified Radical Mastectomy in the Management of Non Metastatic Inflammatory Breast Cancer

QJM ◽

10.1093/qjmed/hcab097.059 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mohamed Elsayed Elshinawi ◽

Ahmed Gamal Eldin Osman ◽

Karim Fahmy Abdelmoaty ◽

Waleed Abdelsalam Abdelatty Anber

Keyword(s):

Breast Cancer ◽

Inflammatory Breast Cancer ◽

Breast Conservation ◽

Radical Mastectomy ◽

Conservative Surgery ◽

Breast Conservation Surgery ◽

Partial Mastectomy ◽

Cochrane Central Register ◽

Modified Radical Mastectomy ◽

Conservation Surgery

Abstract Background Inflammatory breast cancer (IBC), the most lethal form of breast cancer, constitutes 1–2% of all breast cancers in the United States. Multimodality therapy is the standard in management of non metastatic inflammatory breast cancer patients including neoadjuvant chemotherapy and endocrine therapy and mastectomy followed by post mastectomy radiation. A modified radical mastectomy has been the standard surgical procedure of choice. The objective of this systematic review and metanalysis is to estimate the pooled benefits and adverse effects of performing modified radical mastectomy versus breast conservation surgery in the management of non metastatic IBC. Objective To evaluate, review and analyze the outcome of non metastatic IBC patients treated with mastectomy or breast conservation surgery as an integral part of the multimodality treatment of the disease. To highlight the evidence and quality of the included studies. To share in modifying the current guidelines. Methods An electronic search was conducted from the inception till Jan 2020 in the following bibliographic databases: Medline via PubMed, SCOPUS, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Google Scholar to identify relevant articles. We used different combinations of the following queries: ("Inflammatory Breast cancer" OR "breast cancer") AND ("Conservative Treatment" [Mesh] OR "conservative surgery" OR "breast conservative surgery" OR "partial mastectomy"). The search have been done with no limit regarding the year publication. Results After reviewing five studies we found that our results favors the use of modified radical mastectomy over breast conservation surgery in terms of the overall survival and breast cancer specific free survival, however, partial mastectomy could be an effective and safe option in selected group of patients with non metastatic IBC based on the response to NAC an patient’s preference. Conclusions Breast surgery is of great significance to the clinical outcomes of IBC. Standard mastectomy shouldn’t be the only recommended surgical treatment. Individualized surgical procedures can be safely performed in non-metastatic IBC patients based on the response of NAC and patient’s preference.

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Breast conservation surgery (BCS) for breast cancer in a resource limited country- Are we upto the challenge!

Journal of the Pakistan Medical Association ◽

10.47391/jpma.1784 ◽

2022 ◽

Vol 71 (12) ◽

pp. 2748-2754

Author(s):

Nida Javed ◽

Bushra Rehman ◽

Ejaz Iqbal ◽

Sidra Afzal ◽

Aun Jamal ◽

...

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Breast Conservation ◽

Disease Free Survival ◽

Breast Conservation Surgery ◽

Progesterone Receptor Status ◽

Free Survival ◽

Conservation Surgery ◽

Disease Free

Objective: To analyse outcomes of breast conservation surgery and to identify the factors that could have affected the outcomes. Method: The retrospectively study was conducted at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised data of breast conservation surgery cases done between January 2011 and October 2014 in order to cover up for the 5-year follow-up of the last enrolled patient. Data, obtained through the institutional information and database system, included disease-recurrence, 5-year disease-free survival and overall survival. Data was statistically analysed using SPSS 20. Results: Of the 553 cases, 417(75%) had no loco-regional recurrence or distant metastasis, while 136(25%) had some form of loco-regional, distant or contralateral metastasis at 5-year follow-up. In patients who had recurrence or metastasis, only progesterone receptor status, nodal status and mode of treatment showed significant association (p<0.05). Mortality at 5-year follow-up was 77(14%). Amongst the patients who died, only progesterone receptor status and nodal status had significant association (p<0.05). Five-year overall survival for the cohort was 476(86%), whereas 5-year disease-free survival was 409(74%). Conclusion: Breast conservation surgery was found to have favourable outcomes, while progesterone status, nodal involvement and mode of treatment significantly affected the outcome. Key Words: Breast cancer, Breast conserving surgery, 5-year disease free survival, 5-year overall survival Continuous...

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