COULD GENERAL SURGEONS WITH SPECIAL INTEREST IN BREAST SURGERY DELIVER A QUALITY SERVICE DESPITE A PARADIGM SHIFT TOWARDS SPECIALISATION? AN INDEPTH ANALYSIS OF QUALITY ASSESSMENT-BASED PRACTICE AT A GENERAL SURGEON-LED BREAST UNIT IN THE UNITED KINGDOM

Background: Despite specialisation, a small subset of general surgeons continues to provide breast services in the United Kingdom. We aimed to assess breast cancer i) local recurrence rate against the national benchmarks of <5% (for invasive cancer) and <10% (for noninvasive cancer) at 5- year, and ii) net survival rates against national record of 95.8% and 85.3%, at 1-year and 5-year, respectively. Methods: All breast cancers (between 01/05/2012 and 30/04/2013) at a district general hospital in the north-west of England were audited. Two general surgeons provided the breast service. One surgeon performed mostly excisional surgery and acted as a 'generalist'. The second surgeon also performed level 2 oncoplastic procedures and acted as an internal control as a 'specialist'. Results: Out of 270 cancers diagnosed, 203 patients underwent surgery. Six patients (out of 180 invasive cancers) developed local recurrences (3.33%). Two patients (out of 23 patients with Ductal Carcinoma-In-Situ) developed local recurrences (8.69%). There was no signicant intersurgeon variation in practice except a difference in the size of the excised lesions. 1-year and 5-year net survival rates amongst all female breast cancer patients were 97% and 87.3%, respectively. Overall survival at 5-year was 79.1%. Conclusions: The results demonstrate that in an unselected cohort of breast cancer patients, general surgeons with interest in breast surgery can achieve acceptable standards in terms of local recurrence at 5-year, and net survivals at 1-year and 5-year. No conceivable difference in practice between two surgeons with 'generalist' and 'specialist' skill-mix was noted. Low overall survival might reect wider health issues. This has implications in planning a local breast service and utilising constrained human resources in the era of specialisation.

Download Full-text

A retrospective study of inflammatory breast cancer patients from seven hospitals in the United Kingdom.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e11062 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e11062-e11062

Author(s):

Saeed Rafii ◽

Christopher John Poole ◽

Adele Francis ◽

Shalini Chaudhri ◽

Daniel Rea

Keyword(s):

Breast Cancer ◽

United Kingdom ◽

Neoadjuvant Chemotherapy ◽

Cancer Patients ◽

Inflammatory Breast Cancer ◽

Triple Negative ◽

Breast Cancer Patients ◽

The United Kingdom ◽

Her 2 ◽

Clinical Records

e11062 Background: Inflammatory breast cancer (IBC) is an aggressive form of locally advanced breast cancer characterised by rapidly progressive breast erythema, pain and tenderness, oedema and paeu d’orange. It is estimated that between 1-4 % of all newly diagnosed breast cancer patients in the United Kingdom have IBC. Methods: We retrospectively identified 51 patients who were treated for IBC at 7 hospitals in the West midlands area of the United Kingdom between 1997 and 2011. Data including patients’ demographics, clinical, radiological and histopathological characteristics were collected from electronic clinical records. The test for HER-2 over-expression was not carried out routinely before 2002, therefore HER-2 status of such patients were assessed retrospectively on the archived tissues. A cox regression analysis was used for statistical assessment of survival and prognostic factors. Results: Median age at diagnosis was 55 years (range 34-83 yrs). Median overall (OS) and progression free survival (PFS) were 32 months (range 7-97 months) and 27 months (range 2-53 months) respectively. The 3–year survival rate for the entire cohort was 32%. Majority of patients were ER and HER-2 positive (49% and 52% respectively). The rate of complete pathological response (pCR) after neoadjuvant chemotherapy was 14%. All cases who had achieved pCR were HER-2 positive who had received anti HER-2 treatment during the neoadjuvant chemotherapy. The OS for the HER-2 positive patients with pCR was not statistically different from the whole cohort (49 vs 32 months, p=0.09) or from the patients with residual disease (49 vs 26 months, p=0.13). Although the triple negative IBC patients consisted 20% of the cohort, no patients in this group had achieved pCR. The OS and PFS for the triple negative patients were 20 and 14 months respectively. Although the rate of pCR was higher in patients treated with taxane compared to those treated with anthracycline containing chemotherapy (35% vs 7%), there was no significant difference in OS between either of these regimens (29 vs 27 months). Conclusions: HER-2 positive IBC patients had higher rate of achieving pCR after neo-adjuvant anti HER-2 therapy. However higher rate of pCR did not improve the OS.

Download Full-text

Stereotactic radiotherapy of breast cancer liver metastases

Problems in oncology ◽

10.37469/0507-3758-2021-67-3-382-390 ◽

2021 ◽

Vol 67 (3) ◽

pp. 382-390

Author(s):

Sergei Tkachev ◽

Sevil Alieva ◽

Sergey Medvedev ◽

Aleksei Nazarenko ◽

Denis Romanov ◽

...

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Liver Metastases ◽

Cancer Patients ◽

Stereotactic Radiotherapy ◽

Survival Rates ◽

Breast Cancer Patients ◽

Breast Cancer Metastases ◽

Cancer Metastases ◽

Breast Cancer Liver Metastases

Stereotactic body radiation therapy currently occupies its place in the complex treatment of cancer patients with liver metastases. It is assumed that certain groups of patients with breast cancer can benefit from the use of this method, which can be converted into improved overall survival and survival rates without signs of progression of the process. Purpose of the study was to evaluate the efficacy and tolerability of stereotactic radiotherapy in patients with breast cancer metastases in the liver. We have analyzed the results of using stereotactic radiotherapy in 25 breast cancer patients with 43 liver metastases. The treatment was carried out in 3 fractions with a fraction dose of 10-15 Gy and a total dose of 30-45 Gy. Growth of the irradiated lesions was recorded only in 1 case out of 43 metastases (2,3%) and 25 (4%) patients. 1-, 3- and 5-year overall survival rates from the moment of stereotactic radiotherapy were 82,9%, 62% and 38,7%, respectively. Long-term post-radiation adverse events were observed in 8% of cases and did not have a significant effect on the quality of life and the possibility of antitumor treatment. So stereotactic radiotherapy can be recommended as a relatively safe and highly effective method of elimination of breast cancer liver metastases. Taking into account the high achieved local control, further studies on dose escalation in this group of patients are not required.

Download Full-text