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BMC Cancer Jun 2021Because there is no exact therapeutic target, the systemic treatment of triple-negative breast cancer (TNBC) still relies on chemotherapy. In terms of local treatment,...
BACKGROUND
Because there is no exact therapeutic target, the systemic treatment of triple-negative breast cancer (TNBC) still relies on chemotherapy. In terms of local treatment, based on the highly malignant characteristics of TNBC, it is still uncertain whether patients should be given more aggressive local treatment.
METHODS
This study was based on the SEER database. 13,262 TNBC patients undergoing chemotherapy were included. According to local treatment methods, patients were divided into breast-conserving surgery with radiotherapy (BCS + RT), total mastectomy alone and total mastectomy with radiotherapy (Mastectomy+RT). Kaplan-Meier survival analysis drew the survival curves of Overall Survival (OS) and Breast Cancer Specific Survival (BCSS), and Cox proportional risk regression models were used to analyze the impact of different local treatments on OS and BCSS.
RESULTS
After adjusting confounding factors, Mastectomy alone group (HR = 1.57; 95%CI: 1.40-1.77) and Mastectomy+RT group (HR = 1.28; 95%CI: 1.12-1.46) were worse in OS than BCS + RT group, and Mastectomy+RT group (HR = 0.81; 95%CI: 0.73-0.91) was better in OS than Mastectomy alone group. The effect of local treatment for BCSS was similar to that of OS. After stratification according to age, tumor size and lymph node status, when the age was less than 55 years old, at T4, N2 or N3 category, there was no statistical significance between the BCS + RT group and the Mastectomy+RT group in OS or BCSS (all P > 0.05). When the age was less than 65 years old, at T1, T2 or N0 category, there was no statistical significance between the Mastectomy alone group and the Mastectomy+RT group in OS or BCSS (all P > 0.05). The results of other stratified analyses were basically consistent with the results of total population analysis.
CONCLUSION
The survival benefit of breast-conserving surgery with radiotherapy was higher than or similar to that of total mastectomy TNBC patients.
Topics: Aged; Female; Humans; Mastectomy, Simple; Middle Aged; SEER Program; Triple Negative Breast Neoplasms
PubMed: 34147061
DOI: 10.1186/s12885-021-08429-9 -
Breast (Edinburgh, Scotland) Dec 2013Although breast reconstruction following mastectomy plays a role in the psychological impact of breast cancer, only one in three women undergo reconstruction. Few...
INTRODUCTION
Although breast reconstruction following mastectomy plays a role in the psychological impact of breast cancer, only one in three women undergo reconstruction. Few multi-institutional studies have compared complication profiles of reconstructive patients to non-reconstructive.
METHODS
Using the National Surgical Quality Improvement database, all patients undergoing mastectomy from 2006 to 2010, with or without reconstruction, were identified and risk-stratified using propensity scored quintiles. The incidence of complications and comorbidities were compared.
RESULTS
Of 37,723 mastectomies identified, 30% received immediate breast reconstruction. After quintile matching for comorbidities, complications rates between reconstructive and non-reconstructives were similar. This trend was echoed across all quintiles, except in the sub-group with highest comorbidities. Here, the reconstructive patients had significantly more complications than the non-reconstructive (22.8% versus 7.0%, p < 0.001).
CONCLUSION
Immediate breast reconstruction is a well-tolerated surgical procedure. However, in patients with high comorbidities, surgeons must carefully counterbalance surgical risks with psychosocial benefits to maximize patient outcomes.
LEVEL OF EVIDENCE
Level 3.
Topics: Breast Neoplasms; Comorbidity; Female; Humans; Incidence; Mammaplasty; Mastectomy, Simple; Middle Aged; Postoperative Complications; Propensity Score; Registries; Retrospective Studies; Risk Factors
PubMed: 24354013
DOI: 10.1016/j.breast.2013.09.010 -
Annals of Surgical Oncology Mar 1998
Topics: Breast Neoplasms; Dermatologic Surgical Procedures; Female; Humans; Mammaplasty; Mastectomy, Modified Radical; Mastectomy, Simple; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Neoplasm Staging; Neoplasm, Residual; Risk Factors; Surgical Flaps
PubMed: 9625607
DOI: 10.1007/BF02303840 -
BMJ (Clinical Research Ed.) Nov 1988To determine whether, if given the choice, patients with breast cancer would prefer mastectomy or conservation treatment, neither treatment having been shown to be... (Comparative Study)
Comparative Study
STUDY OBJECTIVE
To determine whether, if given the choice, patients with breast cancer would prefer mastectomy or conservation treatment, neither treatment having been shown to be preferable.
DESIGN
Non-randomised case series with 28 patients interviewed after two years and all followed up.
SETTING
Secondary care referral centre.
PATIENTS
153 women, aged less than 65, with T1, T2, N1, and N0 tumours of the breast given the choice of treatment (that is, all eligible patients from December 1979).
INTERVENTIONS
Patients were asked, after information and counselling, which treatment they would prefer. The chosen treatment was given without further question. Mastectomy included node sampling and local radiotherapy if indicated. Conservation treatment comprised excision of the lump, external radiotherapy, and irridium wire implant to tumour bed.
MAIN RESULTS
Conservation treatment was chosen by 54 women and mastectomy by 99. Reasons for preferring mastectomy included desire for rapid treatment for domestic or employment reasons and fear of possibility of future mastectomy. Only two of the sample interviewed regretted their choice. During limited follow up no advantages to either form of treatment were seen in terms of recurrence or survival.
CONCLUSIONS
Patients with breast cancer are capable of choosing treatment and should play a part in deciding which treatment to have. They do not automatically choose to retain the breast.
Topics: Adult; Breast Neoplasms; Combined Modality Therapy; Female; Humans; Mastectomy, Segmental; Mastectomy, Simple; Middle Aged; Neoplasm Recurrence, Local; Patient Acceptance of Health Care; Patient Participation
PubMed: 3144332
DOI: 10.1136/bmj.297.6657.1167 -
Anesthesia and Analgesia Jul 2022Peripheral nerve blocks (PNBs) are used to provide postoperative analgesia after total mastectomy. PNBs improve patient satisfaction and decrease postoperative opioid...
BACKGROUND
Peripheral nerve blocks (PNBs) are used to provide postoperative analgesia after total mastectomy. PNBs improve patient satisfaction and decrease postoperative opioid use, nausea, and vomiting. Few studies have examined whether there is racial-ethnic disparity in the use of PNBs for patients having total mastectomy. We hypothesized that non-Hispanic Asian, non-Hispanic Black, non-Hispanic patients of other races, and Hispanic patients would be less likely to receive a PNB for postoperative analgesia compared to non-Hispanic White patients having total mastectomy. Secondarily, we hypothesized that PNBs would be associated with reduced odds of major complications after total mastectomy.
METHODS
We performed a retrospective cohort study using National Surgical Quality Improvement Program (NSQIP) data from 2015 to 2019. Patients were included if they underwent total mastectomy under general anesthesia. Unadjusted rates of PNB use were compared between race-ethnicity groups. Multivariable logistic regression was performed to determine whether race-ethnicity group was independently associated with receipt of a PNB for postoperative analgesia. Secondarily, we calculated crude and risk-adjusted odds ratios for major complications in patients who received a PNB.
RESULTS
There were 64,103 patients who underwent total mastectomy and 4704 (7.3%) received a PNB for postoperative analgesia. Patients who received a PNB were younger, more commonly women, were less likely to have diabetes and hypertension, and had less disseminated cancer (all P < .05). In our regression analysis, the odds of receiving a PNB differed significantly by race-ethnicity group (P < .001). Non-Hispanic Asian and non-Hispanic Black patients had reduced odds of receiving a PNB compared to non-Hispanic White patients (odds ratio [OR], 0.41; 95% confidence interval [CI], 0.33-0.49 and OR, 0.37 [0.32-0.44]), respectively. Non-Hispanic patients of other races, including American Indian, Alaskan Native, and Pacific Islander, also had reduced odds of receiving a PNB (OR, 0.73 [95% CI, 0.64-0.84]) compared to non-Hispanic White patients, as did Hispanic patients (OR, 0.62 [0.56-0.69]). Patients who received a PNB did not have reduced odds of major complications after mastectomy (crude OR, 0.83 [0.65-1.08]; P = .17 and adjusted OR, 0.85 [0.65-1.10]; P = .21).
CONCLUSIONS
Significant disparity exists in the use of PNBs for postoperative analgesia in patients of different race-ethnicity who undergo total mastectomy in the United States. Continued efforts are needed to better understand the causes of disparity and to ensure equitable access to PNBs.
Topics: Analgesia; Breast Neoplasms; Female; Healthcare Disparities; Humans; Mastectomy; Mastectomy, Simple; Peripheral Nerves; Retrospective Studies; United States; White People
PubMed: 35522889
DOI: 10.1213/ANE.0000000000006058 -
Clinics in Plastic Surgery Oct 1988Total mastectomy is an effective operation for patients who are candidates for a prophylactic mastectomy. This operation removes a larger percentage of breast tissue...
Total mastectomy is an effective operation for patients who are candidates for a prophylactic mastectomy. This operation removes a larger percentage of breast tissue than subcutaneous mastectomy. The cosmetic results of total mastectomy with immediate reconstruction compare favorably with those of subcutaneous mastectomy.
Topics: Adult; Breast Neoplasms; Female; Humans; Mastectomy, Simple; Mastectomy, Subcutaneous; Prostheses and Implants; Risk Factors
PubMed: 3224490
DOI: No ID Found -
Lymphatic Research and Biology Apr 2022Sexual functions in women with lymphedema secondary to breast cancer surgery have not been investigated sufficiently. This study aimed to compare patients with and...
Sexual functions in women with lymphedema secondary to breast cancer surgery have not been investigated sufficiently. This study aimed to compare patients with and without lymphedema after total mastectomy in terms of emotional state, sexual functions, and quality of life. We also investigated the factors affecting sexual functions in these patients. Married women 20-55 years of age, who presented to lymphedema polyclinic of Health Sciences University Ankara Training and Research Hospital after having undergone total mastectomy at least 1 year earlier owing to breast cancer were included. Twenty-five patients with lymphedema were assigned to the lymphedema group, and 20 without lymphedema to the control group. Hospital Anxiety and Depression Scale (HADS) was used to assess emotional state. We evaluated sexual functions of the participants by Female Sexual Function Index (FSFI) and quality of life with European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QOL-C30). There was no statistically significant difference in age and body mass index between the groups ( > 0.05). The mean HADS score was 13.4 ± 6.5 in lymphedema group and 13.4 ± 6.0 in control group. The groups were also similar in aspect of the HADS score ( > 0.05). FSFI and global health and physical function scores of EORTC QOL-C30 were statistically significantly lower in the lymphedema group ( < 0.05). A statistically significant correlation was found between FSFI and age and time elapsed postmenopause ( < 0.05, for both). We evaluated sexual functions of the patients who underwent mastectomy in this study. Although the HADS score is similar in patients with and without lymphedema, both sexual functions and quality of life are adversely affected in patients who undergo mastectomy and develop lymphedema. This study is important for investigating whether lymphedema developing after total mastectomy affects sexual functions of the patients.
Topics: Breast Neoplasms; Female; Humans; Lymphedema; Mastectomy; Mastectomy, Simple; Pilot Projects; Quality of Life; Surveys and Questionnaires
PubMed: 33646047
DOI: 10.1089/lrb.2020.0053 -
Clinical Breast Cancer Oct 2021This systematic review with a meta-regression was conducted to determine the risk of depression after mastectomy compared to breast reconstruction among women with...
This systematic review with a meta-regression was conducted to determine the risk of depression after mastectomy compared to breast reconstruction among women with breast cancer 1 year after surgery. A literature search was conducted according to PRISMA guidelines using 4 databases: Medline (Ovid), Embase, Cinahl, and the Cochrane Library for the period January 2000 to March 2019. Studies that measured the status of depression within 1 year and immediately after surgery were included. Outcomes related to depression were analyzed by using a pool of event rates and a risk ratio of 95% confidence interval (CI), P value, and a fitting model based on the results of a heterogeneity test of mastectomy and BR. The statistical analysis was conducted using Comprehensive Meta-analysis 3.0 software. Nine studies met the inclusion criteria. There were 865 cases of mastectomy only, with a 22.2% risk of depression (95% CI, 12.4-36.2). In 869 women who underwent BR, the risk of depression was 15.7% (95% CI, 8.8-26.2). The depression risk ratio for mastectomy compared to BR was 1.36 (95% CI, 1.11-1.65). Patients with delayed reconstruction exhibited lower levels of depression (risk ratio 0.96, 95% CI 0.57-1.01). The Beck Depression Inventory (BDI) scale showed high sensitivity, and the Hospital Anxiety Depression Scale (HADS) with a cutoff of > 7 could measure even low to moderate depressive symptoms. One in 4 women with breast cancer had symptoms of depression after mastectomy; both surgeries were associated with depression in women 1 year after surgery. Our results will permit the development of proactive treatment plans before and after surgery to mitigate risk and prevent depression through the use of sensitive depression scales like BDI.
Topics: Adaptation, Psychological; Anxiety; Breast Neoplasms; Depression; Female; Humans; Mammaplasty; Mastectomy, Simple; Quality of Life
PubMed: 33541834
DOI: 10.1016/j.clbc.2021.01.003 -
European Radiology Experimental Aug 2019Preoperative evaluation of nipple-areola complex (NAC) tumour involvement is crucial to select patients candidates for nipple-sparing mastectomy. Our aim was to validate...
BACKGROUND
Preoperative evaluation of nipple-areola complex (NAC) tumour involvement is crucial to select patients candidates for nipple-sparing mastectomy. Our aim was to validate a previously developed automated method able to compute the three-dimensional (3D) tumour-to-NAC distance (the most predictive parameter of nipple involvement), using magnetic resonance imaging (MRI) datasets acquired with a scanner and protocol different from those of the development phase.
METHODS
We performed a retrospective analysis of 77 patients submitted to total mastectomy and preoperatively studied with MRI. The new method consisted of automated segmentation of both NAC and tumour and subsequent computation of the 3D distance between them; standard manual two-dimensional segmentation was independently performed. Paraffin-embedded section examination of the removed NAC was performed to identify the neoplastic involvement. The ability of both methods to discriminate between patients with and without NAC involvement was compared using receiver operating characteristic (ROC) analysis.
RESULTS
The 3D tumour-to-NAC distance was correctly computed for 72/77 patients (93.5%); tumour and NAC segmentation method failed in two and three cases, respectively. The diagnostic performance of the 3D automated method at best cut-off values was consistently better than that of the 2D manual method (sensitivity 78.3%, specificity 71.4%, positive predictive value 87.5%, negative predictive value 56.3%, and AUC 0.77 versus 73.9%, 61.2%, 47.2%, 83.3%, and 0.72, respectively), even if the difference did not reach statistical significance (p = 0.431).
CONCLUSIONS
The introduction of the 3D automated method in a clinical setting could improve the diagnostic performance in the preoperative assessment of NAC tumour involvement.
Topics: Breast Neoplasms; Female; Humans; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Mastectomy, Simple; Nipples; Organ Sparing Treatments; Predictive Value of Tests; Preoperative Period; Retrospective Studies
PubMed: 31388834
DOI: 10.1186/s41747-019-0108-3 -
Helvetica Chirurgica Acta May 1992
Review
Topics: Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy, Modified Radical; Mastectomy, Segmental; Mastectomy, Simple; Neoplasm Recurrence, Local; Reoperation; Surgical Flaps
PubMed: 1526827
DOI: No ID Found