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Evaluation of Eligibility and Utilization of Breast Conservation Treatment in an Asian Context

  • Published : 2014.06.15

Abstract

Background: Breast conservation treatment (BCT) has long been recognised to provide survival outcomes equivalent to mastectomy for the treatment of breast cancer. However, published reports of BCT rates in Asian communities are lower than those from Western countries. This study sought to investigate the eligibility and utilisation of BCT in a predominantly Asian population. Materials and Methods: All patients treated surgically by a single surgeon at a private medical facility between 2009 and 2011 were included in the study. Patients were deemed to have successful BCT if they underwent breast conserving surgery with pathologic clear margins and completed all recommended adjuvant treatment. Those who did not complete adjuvant treatment were excluded from the analysis. Results: Data from a total of 161 patients who underwent treatment during the study period were analysed. The mean age was 48.8 years. One hundred and six patients (65.8%) were of Chinese ethnicity, 12 were Indian (7.5%), 11 were Malay (6.8%), 18 were Caucasian (11.2%) and 14 (8.7%) were of other Asian ethnicity. One hundred and thirty-eight women (85.7%) underwent BCT. Of the 23 (14.3%) who underwent mastectomy, 8 (5.4%) elected to undergo a mastectomy despite being eligible for BCT. In total, it was assessed that 146 of 161 patients (90.7%) were eligible for BCT and utilisation was 94.5%. Conclusions: In this study, eligibility, utilisation of BCT and eventual successful breast conservation rates are similar to published rates in Western communities. Additional research is needed to investigate the reasons for the lower published BCT rates in Asian countries and determine ways to improve them.

References

  1. Chuwa EW, Yeo AW, Koong HN, et al (2009). Early detection of breast cancer through population-based mammographic screening in Asian women: a comparison study between screen detected and symptomatic breast cancer. Breast J, 15, 133-9. https://doi.org/10.1111/j.1524-4741.2009.00687.x
  2. Agarwal S, Pappas L, Neumayer L, Kokeny K, Agarwal J (2014) Effect of breast conservation therapy vs mastectomy on disease-specific survival for early-stage breast cancer. JAMA Surg, 149, 267-74. https://doi.org/10.1001/jamasurg.2013.3049
  3. Akkaya N, Atalay NS, Selcuk ST, et al (2011) Impact of body image on quality of life and mood in mastectomized patients and amputees in Turkey. Asian Pac J Cancer Prev, 12, 2669-73.
  4. Chang GH, Chan CW, Hartman M (2011). A commentary on delayed presentation of breast cancer in Singapore. Asian Pac J Cancer Prev, 12, 1635-9.
  5. Dixon JM, Mak C (2008). Predictors of mastectomy in a certified breast centre - the surgeon is an independent risk factor. Breast J, 14, 321-3. https://doi.org/10.1111/j.1524-4741.2008.00591.x
  6. Gadgil A, Roy N, Sankaranarayanan R, Muwonge R, Sauvaget C (2012). Effect of comprehensive breast care on breast cancer outcomes: a community hospital based study from Mumbai. Asian Pac J Cancer Prev, 13, 1105-9. https://doi.org/10.7314/APJCP.2012.13.4.1105
  7. Garcia-Etienne CA, Tomatis M, Heil J, et al (2012). Mastectomy trends for early-stage breast cancer: a report from the EUSOMA multi-institutional European database. Eur J Cancer, 48, 1947-56. https://doi.org/10.1016/j.ejca.2012.03.008
  8. Houssami N, Turner R, Morrow M (2013). Preoperative magnetic resonance imaging in breast cancer. Ann Surg, 257, 249-55. https://doi.org/10.1097/SLA.0b013e31827a8d17
  9. Indelicato D, Grobmyer SR, Newlin H, et al (2007). Association between operative closure type and acute infection, local recurrence, and disease surveillance in patients undergoing breast conserving therapy for early-stage breast cancer. Surgery, 141, 645-53. https://doi.org/10.1016/j.surg.2006.12.011
  10. Lee MC, Rogers K, Griffin K, et al (2009). Determinants of breast conservation rates: reasons for mastectomy at a comprehensive cancer centre. Breast J, 15, 34-40. https://doi.org/10.1111/j.1524-4741.2008.00668.x
  11. Israeli R, Funk S, Reaven NL (2014). Comparative analysis of 18-month outcomes and costs of breast reconstruction flap procedures. Plast Reconstr Surg, 133, 471-9. https://doi.org/10.1097/PRS.0000000000000064
  12. Jung YS, Na KY, Kim KS, Kim SD, Lim DJ (2011) Nation-wide Korean breast cancer data from 2008 using breast cancer registration program. J Breast Cancer, 14, 229-36. https://doi.org/10.4048/jbc.2011.14.3.229
  13. Kronowitz SJ, Feledy JA, Hunt KK, et al (2006) Determining the optimal approach to breast reconstruction after partial mastectomy. Plast Reconstr Surg, 117, 1-11. https://doi.org/10.1097/01.prs.0000194899.01875.d6
  14. McGuire KP, Santillan AA, Kaur P, et al (2009). Are mastectomies on the rise? A 13-year trend analysis of the selection of mastectomy versus breast conservation therapy in 5865 patients. Ann Surg Oncol, 16, 2683-90.
  15. McLaughlin SA (2013). Surgical management of the breast: Breast conservation therapy and mastectomy. Surg Clin N Am, 93, 411-28. https://doi.org/10.1016/j.suc.2012.12.006
  16. Morrow M (2013). Personalising extent of breast cancer surgery according tomolecular subtypes. The Breast, 22, 106-9. https://doi.org/10.1016/j.breast.2013.07.020
  17. Nahabedian MY, Patel KM, Kaminsky AJ, Cocilovo C, Miraliakbari R (2013). Biplanar oncoplastic surgery: a novel approach to breast conservation for small and medium sized breasts. Plast Reconstr Surg, 132, 1081-94. https://doi.org/10.1097/PRS.0b013e3182a3bf47
  18. Omranipour R, Alipour S, Hadji M, Bagheri K (2014). Two decades of experience with ductal carcinoma in situ of the breast in the Cancer Institute of Tehran, Iran. Asia Pac J Cancer Prev, 15, 2771-6. https://doi.org/10.7314/APJCP.2014.15.6.2771
  19. Qiao Q, Zhou G, Ling Y (1997). Breast volume measurement in young Chinese women and clinical applications. Aesthetic Plast Surg, 21, 362-8. https://doi.org/10.1007/s002669900139
  20. Sun MQ, Meng AF, Huang XE, Wang MX (2013). Comparison of psychological influence on breast cancer patients between breast-conserving surgery and modified radical mastectomy. Asian Pac J Cancer Prev, 14, 149-52. https://doi.org/10.7314/APJCP.2013.14.1.149
  21. Rippy EE, Ainsworth R, Sathananthan D, et al (2014). Influences on decision for mastectomy in patients eligible for breast conserving surgery. The Breast, [Epub ahead of print].
  22. Roder D, Zorbas H, Kollias J, et al (2013). Factors predictive of treatment by Australian breast surgeons of invasive female breast cancer by mastectomy rather than breast conserving surgery. Asian Pac J Cancer Prev, 14, 539-45. https://doi.org/10.7314/APJCP.2013.14.1.539
  23. Shameen H, Yip CH, Fong E (2008) Immediate breast reconstruction after mastectomy - why do women choose this option? Asian Pac J Cancer Prev, 9, 409-1.
  24. Tan MP (2007). The boomerang incision for periareolar breast malignancies. Am J Surg, 194, 690-3. https://doi.org/10.1016/j.amjsurg.2006.12.042
  25. Tan MP (2009). An algorithm for the integration of breast magnetic resonance imaging into clinical practice. Am J Surg, 197, 691-3. https://doi.org/10.1016/j.amjsurg.2008.11.020
  26. Tan M. (2009). Areolar-sparing techniques for breast malignancies with nipple discharge. J Am Coll Surg, 208, 1-6. https://doi.org/10.1016/j.jamcollsurg.2008.09.023
  27. Tan M (2010). The 'golf-tee' incision for lower mid-pole peri-areolar cancers. Ann R Coll Surg Engl, 92, 438-9. https://doi.org/10.1308/003588410X12699663903719c
  28. Tan MP (2012). Alternative approaches for oncoplastic breast surgery. Ann Surg Oncol, 19, 2327-33. https://doi.org/10.1245/s10434-012-2261-2
  29. Wang WV, Tan SM, Chow WL (2011). The impact of mammographic breast cancer screening in Singapore: a comparison between screen-detected and symptomatic women. Asian Pac J Cancer Prev, 12, 2735-40.
  30. Woon YY, Chan MYP (2005). Breast conservation surgery-the surgeon factor. The Breast, 14, 131-5. https://doi.org/10.1016/j.breast.2004.08.014
  31. Yau TK, Soong IS, Sze H, et al (2009). Trends and patterns of breast conservation treatment in Hong Kong: 1994-2007. Int J Radiation Oncol Biol Phys, 74, 98-103. https://doi.org/10.1016/j.ijrobp.2008.07.066
  32. Yip CH, Taib NA, Tan GH, et al (2009). Predictors of axillary lymph node metastases in breast cancer: is there a role for minimal axillary surgery? World J Surg, 33, 54-7. https://doi.org/10.1007/s00268-008-9782-7

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