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

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...

OVERVIEW OF PATIENT PREFERENCES IN THE SURGICAL MANAGEMENT PLAN OF EARLY BREAST CANCERS

Objective: To determine patient preferences in the surgical options of early breast cancers and surgeon’s role in the decisionmaking. Study Design: cross-sectional study. Place and Duration of Study: Breast Surgery Department, Combined Military Hospital Rawalpindi Pakistan, from Nov 2020 to May 2021. Methodology: Patients having early carcinoma breast were studied, i.e., clinical stage 1 or 2, and their surgical preference was recorded. The cases were discussed in multidisciplinary meetings, and a discussion session with patient conducted and then final decision taken from the patient was recorded again, and the results compared. Results: A total of 28 patients were included in this study and their surgical preferences recorded. Of these patients 22 (78.5%) agreed to breast conservation initially, whereas one of the patients wanted mastectomy. Five (17.8%) patients were undecided between the two. After multidisciplinary team recommendation and discussion with surgeon, only one patient opted for mastectomy (3.6%). Conclusion: Patients with early breast cancer when offered a surgical decision between breast conservation and mastectomy mostly opt for breast conservation; those who select mastectomy do so because of the fear of recurrence.

BREAST CONSERVING SURGERY AWARENESS AND ACCEPTANCE AMONG FEMALE NURSES IN IRRUA SPECIALIST TEACHING HOSPITAL

Introduction: Breast Conserving Surgery (BCS) is oncologically safe for eligible patients with breast cancer and has enormous physical and psychological benefits. Despite this, the mastectomy rate in many centres is still very high. Nurses are frontline staff in healthcare settings and have great contact with the patients. The level of their awareness would have a great impact on patients eligible for breast conservation seeking expert opinion. This study explored the awareness, perception and acceptance of BCS among female nurses in a rural Nigeria tertiary hospital. Methodology: A quasi-structured self-questionnaire was distributed to 235 nurses using a convenient sampling method. The responses on 219 adequately filled questionnaires were entered into an IBM SPSS Statistics Data Document (version 21.0) for analysis. Categorical variables were presented in counts and percentages. Association between the acceptance of BCS versus its awareness, equivalence to TM and years of nursing practice were tested using Chi-square probability test and a p-value of <0.05 was considered statistically significant. Result: The 219 participants had a good representation of junior and senior nurses among whom 80.4% were at least 45 years old and 82.2% were married. The nurses were mostly general nursing practitioners (76.7%) and 49.3% of the nurses had practised for a duration not less than 10 years of age. The 126 (57.5%) nurses, who described BCS as the surgical removal of a cancerous breast lump short of mastectomy, were considered to be aware of BCS irrespective of their understanding of complementary treatment modalities, eligibilities, comparative advantages to TM and certainty of its oncologic safety. The lack of ready access to radiotherapy centres (54.3%) and delay/overcrowding of these facilities (42.5%) were recognised respectively as major local challenges to BCS practices. The equivalence of BCS to TM was affirmed in 44.3% of the nurses and 35.6% had participated in managing breast cancer patients using the conservative surgical approach. 57.1% were willing to accept BCS or recommend it for an eligible friend or relative and no statistically significant association was observed among those who accepted BCS when matched with the level of awareness or the duration of nursing practice. A higher and significant level of acceptance of BCS was noted among those aware of its oncologic equivalence to TM (p-value = 0.000) Conclusion: This study demonstrated gaps in knowledge of BCS among nurses who are stakeholders in assisting patients make the right decision. This knowledge gap in the perception of BCS will interfere with the ability of the nurse to adequately counsel patients in need of their expert opinion. The awareness of the oncologic equivalence of BCS to TM increased its acceptance significantly. An increase in public awareness and education of nurses is required to improve the acceptance rate of BCS in our practice. Caregivers should also devise effective means of communication to encourage eligible patients for breast conservation

Resection or Preservation? A Tough Surgical Decision for Chinese Breast Cancer Patients Who are in Line with Breast Conserving

Purpose Breast cancer patients who are in line with breast conserving are faced more challenges in making surgery decision, because breast conservation and mastectomy have equivalent oncologic outcomes. The purpose of this study is to analyze the surgical decision-making process for breast cancer patients and further explore the reasons why do Chinese women who are in line with breast conserving are more likely to choose mastectomy. Methods A qualitative study was conducted. With the sample saturation principle, data collected by semi-structured interviews with 24 breast cancer patients who are in line with breast conserving. Colaizzi’s method of phenomenology was used for data analysis. Results Three major themes emerged from the data. The themes were the following: (1) lack of significant decision-making support (stereotyping of breast cancer surgery, inferior quality of interaction with health professions, and without the help of decision aids); (2) can’t mull under the strike (immediacy of the decision, breasts are out of deliberating, and escape); and (3) edified by the Chinese culture (deep family values, hiding concerns about femininity, and conservative character). Conclusions Our findings explore the reasons why more Chinese breast cancer patients with breast conserving conditions choose mastectomy, and help patients to choose knowledge-based treatment options which are concordant with their needs, values, and preferences.

Potential Biomarkers for Predicting the Overall Survival of Kidney Renal Papillary Cell Carcinoma: A Analysis of N6-Methylandenosine-Related lncRNAs

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.