What's new in surgical oncology breast.

It is on the backdrop of advances in tumor biology and systemic therapy for breast cancer, that progress in locoregional treatment has focused on management of the breast for invasive cancer, imaging for staging and therapeutic decision-making, and de-escalation in the management of the axilla.

Occult breast cancer patients with mastectomy have better prognosis than those with breast-conserving therapy.

Background: This single-center retrospective study compared the efficacy of breast-conserving therapy along with axillary lymph node dissection (ALND) with mastectomy and ALND with regard to survival of Chinese patients with occult breast cancer. Materials & methods: Univariate Kaplan-Meier analysis and multivariate Cox proportional hazards model were used to compare treatments and prognosis. Results: A total of 111 patients with a median follow-up of 72.9 months were included. 39 patients with mastectomy + ALND had better disease-free survival than 72 patients with breast-conserving therapy + ALND (HR = 0.31; p = 0.012). Patients with radiotherapy demonstrated inferior survival for both overall survival (HR = 2.67; p = 0.071) and disease-free survival (HR = 5.35; p = 0.002). Surgical strategies and radiotherapy remained significantly predictive of better disease-free survival in multivariate analyses. Conclusion: Mastectomy and ALND demonstrate superior disease-free prognosis compared with breast-conserving therapy and ALND in occult breast cancer.

Impact of the early COVID-19 pandemic on Breast Surgical Oncology fellow education.

INTRODUCTION: The early COVID-19 pandemic rapidly transformed healthcare and medical education. We sought to evaluate the professional and personal impact of the pandemic on 2019-2020 Breast Surgical Oncology (BSO) fellows in Society of Surgical Oncology approved programs to capture the experience and direct future changes. METHODS: From July 15, 2020 to August 4, 2020 a survey was administered to the American Society of Breast Surgeons' fellow members. The survey assessed the impact of the pandemic on clinical experience, education/research opportunities, personal health/well-being, and future career. Responses were collected and aggregated to quantify the collective experience of respondents. RESULTS: Twenty-eight of fifty-seven (54%) eligible fellows responded. Twenty-one (75%) indicated the clinical experience changed. Twenty-seven (96%) reported less time spent caring for ambulatory breast patients and sixteen (57%) reported the same/more time spent in the operating room. Fourteen (50%) stated their future job was impacted and eight (29%) delayed general surgery board examinations. Stress was increased in 26 (93%). Personal health was unaffected in 20 (71%), and 3 (10%) quarantined for COVID-19 exposure/infection. CONCLUSION: The COVID-19 pandemic altered the clinical experience of BSO fellows; however, the operative experience was generally unaffected. The creation of frameworks and support mechanisms to mitigate potential challenges for fellows and fellowship programs in the ongoing pandemic and other times of national crisis should be considered.

Development of Residents' Self-Efficacy in Multidisciplinary Management of Breast Cancer Survey.

BACKGROUND: Treating patients with breast cancer is multidisciplinary; however, it is unclear whether surgery residency programs provide sufficient training in multidisciplinary care. Self-efficacy is one way of measuring the adequacy of training. Our goal was to develop a method of assessing self-efficacy in multidisciplinary breast cancer care. METHODS: Based on a literature review and subject-matter expert input, we developed a 30-item self-efficacy survey to measure six domains of breast cancer care (genetics, surgery, medical oncology, radiation oncology, pathology, and radiology). We constructed and validated the survey using a seven-step survey development framework. The survey was administered to general surgery residents at a single academic surgical residency. RESULTS: Response rate was 66% (n = 31). Internal consistency was strong (Cronbach alpha = 0.92). Self-efficacy was moderate (mean = 3.05) and tended to increase with training (postgraduate year [PGY] 1: mean= 2.37 versus PGY 5: mean= 3.54; P < 0.001), providing evidence for construct validity. Self-efficacy was highest in the surgery (3.56) compared with others (genetics 2.67, medical oncology 3, radiation oncology 2.67, pathology 2.67, and radiology 3.33). This trend was similar across all PGY groups, except for interns, whose self-efficacy in surgery was low. CONCLUSIONS: We created a survey to assess self-efficacy in multidisciplinary breast cancer care and provided initial evidence of survey validity. Although self-efficacy in surgery improved with years in training, medical and radiation oncology self-efficacy remained low. As modern breast cancer treatment is highly multidisciplinary, an expanded education program is needed to help trainees incorporate multidisciplinary clinical perspectives.

Evaluating the Accuracy, Quality, and Readability of Online Breast Cancer Information.

Objective: To assess the accuracy, quality, and readability of patient-focused breast cancer websites using expert evaluation and validated tools. Background: Ensuring access to accurate, high-quality, and readable online health information supports informed decision-making and health equity but has not been recently evaluated. Methods: A qualitative analysis on 50 websites was conducted; the first 10 eligible websites for the following search terms were included: "breast cancer," "breast surgery," "breast reconstructive surgery," "breast chemotherapy," and "breast radiation therapy." Websites were required to be in English and not intended for healthcare professionals. Accuracy was evaluated by 5 breast cancer specialists. Quality was evaluated through the DISCERN questionnaire. Readability was measured using 9 standardized tests. Mean readability was compared with the American Medical Association and National Institutes of Health 6th grade recommendation. Results: Nonprofit hospital websites had the highest accuracy (mean = 4.06, SD = 0.42); however, no statistical differences were observed in accuracy by website affiliation (P = 0.08). The overall mean quality score was 50.8 ("fair"/"good" quality) with no significant differences among website affiliations (P = 0.10). Mean readability was at the 10th grade reading level, the lowest being for commercial websites with a mean 9th grade reading level (SD = 2.38). All websites exceeded the American Medical Association- and National Institutes of Health-recommended reading level by 4.4 levels (P < 0.001). Websites with higher accuracy tended to have lower readability levels, whereas those with lower accuracy had higher readability levels. Conclusion: As breast cancer treatment has become increasingly complex, improving online quality and readability while maintaining high accuracy is essential to promote health equity and empower patients to make informed decisions about their care.

Lessons from other fields of medicine, Part 1: Breast cancer.

Through the understanding of multiple etiologies, pathologies, and disease progression trajectories, breast cancer shifted historically from a singular malignancy of the breast to a complex of molecular/biological entities, translating into individualized disease-modifying treatments. As a result, this led to various de-escalations of treatment compared with the gold standard in the era preceding systems biology: radical mastectomy. Targeted therapies have minimized morbidity from the treatments and mortality from the disease. Biomarkers further individualized tumor genetics and molecular biology to optimize treatments targeting specific cancer cells. Landmark discoveries in breast cancer management have evolved through histology, hormone receptors, human epidermal growth factor, single-gene prognostic markers, and multigene prognostic markers. Relevant to the reliance on histopathology in neurodegenerative disorders, histopathology evaluation in breast cancer can serve as a marker of overall prognosis rather than predict response to therapies. This chapter reviews the successes and failures of breast cancer research through history, with focus on the transition from a universal approach for all patients to divergent biomarker development and individualized targeted therapies, discussing future areas of growth in the field that may apply to neurodegenerative disorders.

Trends in leadership at breast surgical oncology fellowships.

Introduction: Breast surgical oncology is a defined sub-specialty of general surgery that focuses on the surgical management of breast disease and malignancy within a multidisciplinary context. The fellowship directors (FD) that lead these programs have been selected for their abilities. As programs do research to ensure proper training for the next generation of breast surgical oncologists, we wanted to look into the FDs responsible for their training. Methods: The Breast Surgical Oncology care program list was compiled via the Society of Surgical Oncology and American Society of Breast Surgeons Accredited programs (n = 60). The demographic information that was of interest included, but was not limited to, gender, age, ethnicity/background, past residency training, past fellowship training, year graduated from residency and fellowship, year since graduation to FD appointment, time at institution till FD appointment, and Hirsch index (h-index). Results: Data were collected on all 60 FDs. The average age of FDs was 52 years old, 27% of FDs are men and 73% of FDs are women. The average H-index, number of publications, and number of citations were 19, 67, and 2648, respectively. The mean graduation year from residency was 2003, and from fellowship was 2006; with a mean of 9 years post fellowship graduation until becoming an FD. The most frequently attended residency was Rush (n = 4), and the most common fellowships were Memorial Sloan Kettering (n = 8), MD Anderson Cancer Center (n = 7), and John Wayne Cancer Institute (n = 4). Nine of the FDs stayed at the same institution after doing both residency and fellowship there (15%). Conclusion: This is the first study to examine the demographics of those in FD positions in Surgical Breast Oncology, which is a relatively young fellowship. We found that FDs in Breast Surgical Oncology are defined by their high output of research. This qualification may be why the average age, and the number of years to FD are higher compared to other specialties where this research has been undertaken. Initial evaluation of FDs suggest more diversity in this field is needed. Further insight into the leaders training our next generation of surgeons is warranted.

The Impact of COVID-19 on Breast Surgery Fellowships.

Purpose of Review: Across the world, medical training has been affected by the COVID-19 virus and this has changed the way physicians are educated. What is less clear is the effect of the pandemic on breast surgical oncology fellows who were in training during this time. This review discusses the experience of breast surgical oncology fellows during the pandemic and how fellowships adapted to preserve the educational experience and conserve the quality of training. Recent Findings: The challenges and changes experienced by breast surgery fellows during the COVID-19 pandemic have proved to be sudden shifts in not only fellowship training, but future patient care and research opportunities, all while confronting the global impact of a deadly pandemic. While experiences between fellowships varied, the similarities and differences encountered highlight the regional and temporal differences in how fellowships responded to the pandemic. Summary: Breast surgical oncology fellowship is one year long, with every day allocated to ensure the surgeon has a deep understanding of the multidisciplinary approach to this ever-evolving field. As the pandemic spread and affected different regions with varying severity, elective cases were canceled, resources were re-allocated, and uncertainty abounded. At the same time, novel approaches to fellowship training were rapidly implemented. It will take time and additional research to fully understand the long-term consequences for trainees affected during their breast surgery fellowship.

Delving deeper into disparity: The impact of health literacy on the surgical care of breast cancer patients.

BACKGROUND: Breast surgical oncology is a unique field that involves complex cancer management and longstanding patient interactions with the healthcare system, making it potentially challenging for patients with low health literacy. The purpose of this review is to summarize the current knowledge regarding health literacy in breast cancer and identify future directions for research and potential intervention in breast surgical oncology. DATA SOURCES: A search of relevant literature querying PubMed and Science Direct was performed and included the following keywords: health literacy, breast cancer, breast surgical oncology, surgery, outcomes, prevention, screening, healthcare utilization, chronic disease. CONCLUSIONS: Limited health literacy may detrimentally affect understanding and outcomes in breast surgical oncology. Identifying ways providers can improve patient understanding and utilization of health information is important, and surgeons may have a pivotal role. Further studies addressing health literacy in breast surgical oncology is needed in order to better optimize care of patients.

Training of breast surgical oncologists.

Breast surgical oncology is a defined sub-specialty of general surgery with focus on the surgical management of breast disease and malignancy within a multidisciplinary context. Much of the training of breast surgical oncologists in the United States exists within a fellowship training structure with oversight and approval by the Society of Surgical Oncology (SSO). Rapid continuous changes in breast oncology practice have further substantiated dedicated expertise in breast surgical oncology. Training programs are structured to develop proficiency in fellows for advanced surgical techniques and clinical decision-making as well as exposure to the multidisciplinary aspects of breast cancer management. Components of a successful program include an intense multidisciplinary curriculum, engagement in clinical research and attention to strong mentorship. National curriculum and training requirements as well as supplemental resources assist in standardizing the fellowship experience. As surgical training and the field of breast oncology continues to evolve, so do fellowship training programs to ensure high quality breast surgical oncologists equipped to deliver high quality evidence based patient care while continuing to drive future research and trainee education.