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BMC Cancer Aug 2023Women with early breast cancer who meet guideline-based criteria should be offered breast conserving surgery (BCS) with adjuvant radiotherapy as an alternative to... (Comparative Study)
Comparative Study Observational Study
Receipt of mastectomy and adjuvant radiotherapy following breast conserving surgery (BCS) in New Zealand women with BCS-eligible breast cancer, 2010-2015: an observational study focusing on ethnic differences.
BACKGROUND
Women with early breast cancer who meet guideline-based criteria should be offered breast conserving surgery (BCS) with adjuvant radiotherapy as an alternative to mastectomy. New Zealand (NZ) has documented ethnic disparities in screening access and in breast cancer treatment pathways. This study aimed to determine whether, among BCS-eligible women, rates of receipt of mastectomy or radiotherapy differed by ethnicity and other factors.
METHODS
The study assessed management of women with early breast cancer (ductal carcinoma in situ [DCIS] and invasive stages I-IIIA) registered between 2010 and 2015, extracted from the recently consolidated New Zealand Breast Cancer Registry (now Te Rēhita Mate Ūtaetae NZBCF National Breast Cancer Register). Specific criteria were applied to determine women eligible for BCS. Uni- and multivariable analyses were undertaken to examine differences by demographic and clinicopathological factors with a primary focus on ethnicity (Māori, Pacific, Asian, and Other; the latter is defined as NZ European, Other European, and Middle Eastern Latin American and African).
RESULTS
Overall 22.2% of 5520 BCS-eligible women were treated with mastectomy, and 91.1% of 3807 women who undertook BCS received adjuvant radiotherapy (93.5% for invasive cancer, and 78.3% for DCIS). Asian ethnicity was associated with a higher mastectomy rate in the invasive cancer group (OR 2.18; 95%CI 1.72-2.75), compared to Other ethnicity, along with older age, symptomatic diagnosis, advanced stage, larger tumour, HER2-positive, and hormone receptor-negative groups. Pacific ethnicity was associated with a lower adjuvant radiotherapy rate, compared to Other ethnicity, in both invasive and DCIS groups, along with older age, symptomatic diagnosis, and lower grade tumour in the invasive group. Both mastectomy and adjuvant radiotherapy rates decreased over time. For those who did not receive radiotherapy, non-referral by a clinician was the most common documented reason (8%), followed by patient decline after being referred (5%).
CONCLUSION
Rates of radiotherapy use are high by international standards. Further research is required to understand differences by ethnicity in both rates of mastectomy and lower rates of radiotherapy after BCS for Pacific women, and the reasons for non-referral by clinicians.
Topics: Female; Humans; Breast Neoplasms; Carcinoma, Intraductal, Noninfiltrating; Maori People; Mastectomy; Mastectomy, Segmental; New Zealand; Radiotherapy, Adjuvant; Pacific Island People; Asian; European People; Middle Eastern People; African People
PubMed: 37592208
DOI: 10.1186/s12885-023-11248-9 -
Gland Surgery Apr 2024Risk of local recurrence (LR) (and even distant disease-free survival) after mastectomy is associated with margin status. Furthermore, the vast majority of LR are... (Review)
Review
Risk of local recurrence (LR) (and even distant disease-free survival) after mastectomy is associated with margin status. Furthermore, the vast majority of LR are located at the anterior (superficial) margin. Margins in mastectomy are considered anatomical borders and not true resection margins; such a conception may erroneously lead to underestimation of the risk of LR after mastectomy. If dissection is accurate along the fascia, only skin, subcutaneous tissue and minimal residual breast gland tissue (rBGT) are expected to remain in the patient. However, the subcutaneous fascia is an inconsistent anatomical structure that may be absent in almost half of patients. Studies and routine clinical practice suggest that resection may frequently, though often focally, be within the breast glandular tissue leaving various amounts of rBGT. Such areas may be nidus for subsequent de novo or recurrent premalignant or malignant disease. There is no consensus on handling of close/positive margins and intervention is extrapolated from studies on breast conserving surgery with subsequent radiotherapy. Handling of a close/positive margin is complicated by poor correlation between the findings on the specimen and the attempt to relocate the area of concern in a patient with reconstructed breasts. In this clinical practice review, we strongly advocate for reporting of the lesion-to-margin distance in mastectomies to collect further evidence on the association between LR and margin status.
PubMed: 38720674
DOI: 10.21037/gs-23-407 -
Journal of Cancer Research and Clinical... Dec 2023Among all primary breast tumors, malignant phyllodes tumor of the breast (MPTB) make up less than 1%. In the treatment of phyllode tumors, surgical procedures such as... (Observational Study)
Observational Study
PURPOSE
Among all primary breast tumors, malignant phyllodes tumor of the breast (MPTB) make up less than 1%. In the treatment of phyllode tumors, surgical procedures such as mastectomy and breast-conserving surgery are the mainstay. MPTB has, however, been controversial when it comes to treating it with RT. We aimed to explore the prognostic impact of RT and other clinicopathologic factors on long-term survival for patients with stage T3 or T4 malignant phyllodes tumors.
METHODS
We select patients with stage T3 or T4 MPTB who qualified for the criteria between 2000 and 2018 via the Surveillance, Epidemiology, and End Results (SEER) database. We performed 1:1 propensity score matching (PSM) and Kaplan-Meier analysis to explore the role of RT in long-term survival of patients with stage T3 or T4 MPTB. A univariate and multivariate analysis of breast cancer-specific survival (BCSS) and overall survival (OS) risk factors was carried out using a Cox proportional hazards model. In addition, the nomogram graph of OS and BCSS was constructed.
RESULTS
A total of 583 patients with stage T3 or T4 malignant phyllodes tumors were included in this study, of whom 154 (26.4%) received RT, and 429 (73.6%) were treated without RT. Before adjustment, between groups with and without RT, BCSS (p = 0.1) and OS (p = 0.212) indicated no significant difference respectively. Using of PSM, the two groups still did not differ significantly in BCSS (p = 0.552) and OS (p = 0.172). In multivariate analysis, age (p < 0.001), surgery of primary site (p < 0.001) and distant metastatic status (p < 0.001) were related to prognosis, while RT still did not affect BCSS (p = 0.877) and OS (p = 0.554).
CONCLUSION
Based on the SEER database analysis, the study suggests that the patients with stage T3 or T4 MPTB treated with RT after surgery didn't have significant differences in BCSS or OS compared to those not treated with RT.
Topics: Humans; Female; Breast Neoplasms; Phyllodes Tumor; Mastectomy; Breast; Databases, Factual
PubMed: 38153521
DOI: 10.1007/s00432-023-05517-0 -
Supportive Care in Cancer : Official... Feb 2024The dermopigmentation of the Nipple-Areola Complex (NAC) is a safe non-surgical reconstruction technique that can restore psychophysical integrity, representing the... (Review)
Review
PURPOSE
The dermopigmentation of the Nipple-Areola Complex (NAC) is a safe non-surgical reconstruction technique that can restore psychophysical integrity, representing the final step after oncological surgery. This scoping review aims to identify and synthesize the literature focused on medical tattooing for NAC reconstruction in women who underwent breast reconstruction after cancer surgery. Competence and training, outcomes and organizational aspects were assessed as specific outcomes.
METHODS
The Joanna Briggs Institute (JBI) methodology for scoping reviews was followed. MEDLINE, Embase, Cochrane Library, Clinical Key, Scopus and Cinahl databases were consulted. After title (N = 54) and abstract (N = 39) screening and full-text review (N = 18), articles that met eligibility criteria were analyzed, critically apprised and narratively synthesized.
RESULTS
13 articles were analysed, with full texts (N = 11) and only abstract (N = 2). The overall quality of the literature (N observational studies = 11; N pilot experimental studies = 2) is weak. Nurses were the professionals mostly involved (N = 6), then medical staff (N = 4) and tattoo artists (N = 2). The professional training is poorly described in 6 papers. The most frequently assessed outcome was the satisfaction rate (N = 8). One study explored aspects of quality of life with a validated questionnaire. The management of these services resulted variable. Nurse-led services were implemented in 2 studies.
CONCLUSION
Despite methodological weaknesses, NAC tattooing research is relevant because it helps women redefine their identity after demolitive cancer treatments. Further research on processes and outcomes is needed.
Topics: Female; Humans; Tattooing; Nipples; Quality of Life; Mastectomy; Mammaplasty; Breast Neoplasms; Retrospective Studies
PubMed: 38337084
DOI: 10.1007/s00520-024-08351-3 -
CMAJ : Canadian Medical Association... Feb 2024
Topics: Humans; Decision Making; Withholding Treatment; Genetic Predisposition to Disease; Genes, BRCA2; Genes, BRCA1; Genetic Counseling; Prophylactic Mastectomy
PubMed: 38378220
DOI: 10.1503/cmaj.230750 -
CMAJ : Canadian Medical Association... Oct 2023
Topics: United States; Humans; Female; Mastectomy; Breast Neoplasms; Retrospective Studies
PubMed: 37788839
DOI: 10.1503/cmaj.230801 -
BMC Women's Health Nov 2023The purpose was to compare the effects of manual lymphatic drainage and soft tissue mobilization on pain threshold, shoulder mobility and quality of life in patients... (Randomized Controlled Trial)
Randomized Controlled Trial
Comparative effects of lymphatic drainage and soft tissue mobilization on pain threshold, shoulder mobility and quality of life in patients with axillary web syndrome after mastectomy.
PURPOSE
The purpose was to compare the effects of manual lymphatic drainage and soft tissue mobilization on pain threshold, shoulder mobility and quality of life in patients with axillary web syndrome.
METHODS
This randomized clinical trial was conducted on 36 breast cancer patients with developed axillary web; participants were randomly divided into two groups. One group was treated with manual lymphatic drainage; the other group was treated with soft tissue mobilizations in addition to therapeutic exercises, i.e., stretching, strengthening and range of motion (ROM) exercises. The duration of treatment was four weeks (5 sessions/week), with therapeutic exercises as a common treatment protocol. Outcome measures were Breast-Cancer specific quality of life questionnaires, Disabilities of the Arm, Shoulder and Hand (DASH), Numeric Pain Rating Scale (NPRS), Patient Specific Functional Scale (PSFS), Dynamometer and Goniometer. All outcome measure readings were recorded at baseline and the end (4th week) of the treatment.
RESULTS
The compliance of the variable distribution with normal distribution was verified using the Shaphiro-Wilk test. Parametric tests were applied, and both groups showed significant effects (p < 0.05) in pairwise comparison (paired t-test). The comparison group analysis (independent t-test) showed that there was no significant difference in pain, upper limb strength, range of motions and fatigue component of quality of life questionnaire parameters (p > 0.05). Two parameters (DASH, PSFS) and one component of the quality of life questionnaire (global health) showed a significant difference (p < 0.05).
CONCLUSION
Manual lymphatic drainage showed more improvement in functional movements. It was concluded that both groups, manual lymphatic drainage and soft tissue mobilization groups were clinically equally effective.
TRIAL REGISTRATION NUMBER
This trial is registered at ClinicalTrial.gov PRS under trial number NCT05463185 on date 18/07/2022.
Topics: Humans; Female; Shoulder; Mastectomy; Breast Neoplasms; Pain Threshold; Quality of Life; Upper Extremity; Pain; Range of Motion, Articular; Treatment Outcome
PubMed: 37950230
DOI: 10.1186/s12905-023-02762-w -
Current Oncology (Toronto, Ont.) Jul 2023Breast reconstruction is generally discouraged in women with inflammatory breast cancer (IBC) due to concerns with recurrence and poor long-term survival. We aim to... (Review)
Review
Breast reconstruction is generally discouraged in women with inflammatory breast cancer (IBC) due to concerns with recurrence and poor long-term survival. We aim to determine contemporary trends and predictors of breast reconstruction and its impact on oncologic outcomes among women with IBC. A systematic literature review for all studies published up to 15 September 2022 was conducted via MEDLINE, Embase, and the Cochrane Library. Studies comparing women diagnosed with IBC undergoing a mastectomy with or without breast reconstruction were evaluated. The initial search yielded 225 studies, of which nine retrospective cohort studies, reporting 2781 cases of breast reconstruction in 29,058 women with IBC, were included. In the past two decades, immediate reconstruction rates have doubled. Younger age, higher income (>USD 25,000), private insurance, metropolitan residence, and bilateral mastectomy were associated with immediate reconstruction. No significant difference was found in overall survival, breast cancer-specific survival or recurrence rates between women undergoing versus not undergoing (immediate or delayed) reconstruction. There is a paucity of data on delayed breast reconstruction following IBC. Immediate breast reconstruction may be a consideration for select patients with IBC, although prospective data is needed to clarify its safety.
Topics: Humans; Female; Mastectomy; Inflammatory Breast Neoplasms; Retrospective Studies; Prospective Studies; Mammaplasty
PubMed: 37504349
DOI: 10.3390/curroncol30070489 -
Journal of Cancer Research and... Dec 2023The aim of this study was to compare the advantages and disadvantages of intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) in...
Dosimetry of intensity-modulated radiation therapy and volumetric-modulated arc therapy techniques after modified radical mastectomy for breast cancer and hypofractionated intensity-modulated radiotherapy.
OBJECTIVE
The aim of this study was to compare the advantages and disadvantages of intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) in patients with left-sided breast cancer who underwent hypofractionated IMRT after a modified radical mastectomy.
MATERIALS AND METHODS
Twenty patients who required adjuvant radiotherapy after modified radical mastectomy were randomly selected, and a specified dose of 43.5 Gy/15 F was used to plan for IMRT or VMAT. Dose-volume histograms (DVHs) were utilized to evaluate the dose distribution of the planning target volumes (PTVs) and organs at risk (OARs).
RESULTS
VMAT demonstrated a greater and more uniform dose distribution of PTVs and lower number of monitor units. No significant differences were found in V5 of the affected lung and heart between the two techniques (P > 0.05). The V10, V20, V30, and Dmean of the affected lung and V10, V20, V30, V40, Dmean, and Dmax of the whole heart were better in the VMAT than in the IMRT (P < 0.05). The Dmean and Dmax of the left anterior descending (LAD) branch of the coronary artery of the heart were better in the VMAT (P < 0.05), and the use of the VMAT effectively reduced the cardiopulmonary dose. A significant advantage of V30 and Dmean was also found in VMAT (P < 0.05).
CONCLUSION
These findings indicate that VMAT has higher clinical significance than IMRT, because it improved the dose distribution in the target area, reduced the cardiopulmonary dose, protected the OARs (e.g. thyroid), and shortened the treatment duration.
Topics: Humans; Female; Breast Neoplasms; Radiotherapy, Intensity-Modulated; Mastectomy, Modified Radical; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Mastectomy; Organs at Risk
PubMed: 38156923
DOI: 10.4103/jcrt.jcrt_51_23 -
Aesthetic Plastic Surgery Dec 2023Most of the time, female-to-male (FtoM) chest surgery involves mastectomy techniques and free transplantation of the nipple-areola complex. With the increasing...
INTRODUCTION
Most of the time, female-to-male (FtoM) chest surgery involves mastectomy techniques and free transplantation of the nipple-areola complex. With the increasing prevalence of gender dysphoria and the demand for female-to-male gender reassignment surgery, the need for FtM top surgery is also rising. To meet this demand, we present a new approach: the PIPe technique, based on a fasciocutaneous flap with a posteroinferior pedicle.
MATERIALS AND METHODS
All patients with FtoM gender dysphoria undergoing surgery using the posteroinferior pedicle flap technique in the Plastic Surgery Department at Rennes University Hospital Center were included. The procedure involved extensive liposuction of the lower internal and external mammary quadrants, followed by liposuction of deep tissues in the upper quadrants, except in the pedicle area. After removing skin from the lower quadrants down to the dermis and de-epithelializing the posteroinferior pedicle flap, the thoracic flap was lowered and the areola transposed.
RESULTS
From July 2022 to March 2023, fifteen patients underwent surgery, and their results were collected prospectively. The average age was 25 years, the mean weight was 76.6 kg, and the average BMI was 28.1 kg/m. The average operating time was 102 min, and the mean weight excised was 459.5 g. The average length of hospital stay was 3.3 days, and the drainage duration was 2.4 days. No major complications were reported, and there were no cases of reintervention or recurrence.
CONCLUSIONS
Our study presents a novel surgical approach utilizing the posteroinferior pedicle technique. Its key benefit lies in the preservation of neurovascular function, which makes it an attractive option for patients seeking to retain nipple sensitivity. This procedure is reliable, reproducible, and recommended as a first-line treatment for grade II and III gynecomastia due to its low rate of major complications and favorable functional and aesthetic outcomes.
LEVEL OF EVIDENCE IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Topics: Humans; Male; Female; Adult; Sex Reassignment Surgery; Breast Neoplasms; Mammaplasty; Mastectomy; Retrospective Studies; Nipples; Esthetics; Treatment Outcome
PubMed: 37684416
DOI: 10.1007/s00266-023-03552-3