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BACKGROUND: This study evaluated the accuracy, clinical concordance, and readability of the chatbot interface generative pretrained transformer (ChatGPT) 3.5 as a source of breast cancer information for patients. METHODS: Twenty questions that patients are likely to ask ChatGPT were identified by breast cancer advocates. These were posed to ChatGPT 3.5 in July 2023 and were repeated three times. Responses were graded in two domains: accuracy (4-point Likert scale, 4 = worst) and clinical concordance (information is clinically similar to physician response; 5-point Likert scale, 5 = not similar at all). The concordance of responses with repetition was estimated using intraclass correlation coefficient (ICC) of word counts. Response readability was calculated using the Flesch Kincaid readability scale. References were requested and verified. RESULTS: The overall average accuracy was 1.88 (range 1.0-3.0; 95% confidence interval [CI], 1.42-1.94), and clinical concordance was 2.79 (range 1.0-5.0; 95% CI, 1.94-3.64). The average word count was 310 words per response (range, 146-441 words per response) with high concordance (ICC, 0.75; 95% CI, 0.59-0.91; p < .001). The average readability was poor at 37.9 (range, 18.0-60.5) with high concordance (ICC, 0.73; 95% CI, 0.57-0.90; p < .001). There was a weak correlation between ease of readability and better clinical concordance (-0.15; p = .025). Accuracy did not correlate with readability (0.05; p = .079). The average number of references was 1.97 (range, 1-4; total, 119). ChatGPT cited peer-reviewed articles only once and often referenced nonexistent websites (41%). CONCLUSIONS: Because ChatGPT 3.5 responses were incorrect 24% of the time and did not provide real references 41% of the time, patients should be cautioned about using ChatGPT for medical information.
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IMPORTANCE: Nearly 75% of newly diagnosed cancer patients in the United States will receive care from a hospital that is accredited by the Commission on Cancer (CoC). To support hospitals in their quality assurance efforts, the CoC maintains a portfolio of quality measures to give hospitals compliance data with select best practices for cancer care. As the CoC quality measures have evolved over recent years, many clinicians may lack awareness of the intent and content of the measure portfolio, as well as the mechanism by which new measures originate. OBSERVATIONS: The CoC quality measures are based on data that hospitals submit to the National Cancer Database, allowing the CoC to track compliance with a subset of consensus best practices. Each year, new measures are designed by diverse teams of specialists in the different treatment modalities for the tumor types covered by the portfolio. These proposed measures are then subjected to a range of vetting, refinement, and prioritization steps before being voted into the portfolio by the Quality Assurance and Data Committee of the CoC. Over the past 4 years, the CoC has worked to renovate not only the portfolio but also the process used to create and launch new measures, revise existing measures, and retire obsolete measures. CONCLUSION AND RELEVANCE: In the following overview, we outline the current measure process, highlight important changes to the portfolio, and share opportunities to further increase the impact.
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Neoplasias , Humanos , Estados Unidos , Neoplasias/terapia , Garantía de la Calidad de Atención de Salud , Indicadores de Calidad de la Atención de SaludRESUMEN
BACKGROUND: The technical aspects of cancer surgery have a significant impact on patient outcomes. To monitor surgical quality, in 2020, the Commission on Cancer (CoC) revised its accreditation standards for cancer surgery and introduced the synoptic operative reports (SORs). The standardization of SORs holds promise, but successful implementation requires strategies to address key implementation barriers. This study aimed to identify the barriers and facilitators to implementing breast SOR within diverse CoC-accredited programs. METHODS: In-depth semi-structured interviews were conducted with 31 health care professionals across diverse CoC-accredited sites. The study used two comprehensive implementation frameworks to guide data collection and analysis. RESULTS: Successful SOR implementation was impeded by disrupted workflows, surgeon resistance to change, low prioritization of resources, and poor flow of information despite CoC's positive reputation. Participants often lacked understanding of the requirements and timeline for breast SOR and were heavily influenced by prior experiences with templates and SOR champion relationships. The perceived lack of monetary benefits (to obtaining CoC accreditation) together with the significant information technology (IT) resource requirements tempered some of the enthusiasm. Additionally, resource constraints and the redirection of personnel during the COVID-19 pandemic were noted as hurdles. CONCLUSIONS: Surgeon behavior and workflow change, IT and personnel resources, and communication and networking strategies influenced SOR implementation. During early implementation and the implementation planning phase, the primary focus was on achieving buy-in and initiating successful roll-out rather than effective use or sustainment. These findings have implications for enhancing standardization of surgical cancer care and guidance of future strategies to optimize implementation of CoC accreditation standards.
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Acreditación , Neoplasias de la Mama , Humanos , Neoplasias de la Mama/cirugía , Femenino , COVID-19/epidemiología , Flujo de Trabajo , Oncología Quirúrgica/normas , SARS-CoV-2 , Cirujanos/normasRESUMEN
Rates of contralateral mastectomy (CM) among patients with unilateral breast cancer have been increasing in the United States. In this Society of Surgical Oncology position statement, we review the literature addressing the indications, risks, and benefits of CM since the society's 2017 statement. We held a virtual meeting to outline key topics and then conducted a literature search using PubMed to identify relevant articles. We reviewed the articles and made recommendations based on group consensus. Patients consider CM for many reasons, including concerns regarding the risk of contralateral breast cancer (CBC), desire for improved cosmesis and symmetry, and preferences to avoid ongoing screening, whereas surgeons primarily consider CBC risk when making a recommendation for CM. For patients with a high risk of CBC, CM reduces the risk of new breast cancer, however it is not known to convey an overall survival benefit. Studies evaluating patient satisfaction with CM and reconstruction have yielded mixed results. Imaging with mammography within 12 months before CM is recommended, but routine preoperative breast magnetic resonance imaging is not; there is also no evidence to support routine postmastectomy imaging surveillance. Because the likelihood of identifying an occult malignancy during CM is low, routine sentinel lymph node surgery is not recommended. Data on the rates of postoperative complications are conflicting, and such complications may not be directly related to CM. Adjuvant therapy delays due to complications have not been reported. Surgeons can reduce CM rates by encouraging shared decision making and informed discussions incorporating patient preferences.
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Neoplasias de la Mama , Oncología Quirúrgica , Neoplasias de Mama Unilaterales , Humanos , Femenino , Mastectomía/métodos , Neoplasias de la Mama/patología , Neoplasias de Mama Unilaterales/cirugía , Oncología MédicaRESUMEN
INTRODUCTION: Oncoplastic breast conservation surgery (BCS) uses concurrent reduction and/or mastopexy with lumpectomy to improve aesthetic outcomes. However, tissue rearrangement can shift the original tumor location site in relation to external breast landmarks, resulting in difficulties during re-excision for a positive margin and accurate radiation targeting. We developed the Breast Intraoperative Oncoplastic (BIO) form to help depict the location of the tumor and breast reduction specimen. This study seeks to assess physician perspectives of the implementation outcomes. METHODS: From February 2021 to April 2021, the BIO form was used in 11 oncoplastic BCS cases at a single institution. With institutional review board approval, surgical oncologists (SOs), plastic surgeons (PSs), and radiation oncologists (ROs) were administered a 12-question validated survey on Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM), using a 5-point Likert scale during initial implementation and at 6-month reassessment. RESULTS: Twelve physicians completed the survey initially (4 SOs, 4 PSs, and 4 ROs). The mean scores for Acceptability of Intervention Measure, Intervention Appropriateness Measure, and Feasibility of Intervention Measure were high (4.44, 4.56, and 4.56, respectively). Twelve completed the second survey (5 SOs, 3 PSs, and 4 ROs). The mean scores were marginally lower (4.06, 4.21, and 4.25). There were no significant differences when stratified by number of years in practice or specialty. Free text comments showed that 75% of physicians found the form helpful in oncoplastic BCS. CONCLUSIONS: The data indicate high feasibility, acceptability, and appropriateness of the BIO form. Results of this study suggest multidisciplinary benefits of implementing the BIO form in oncoplastic BCS.
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Mamoplastia , Mastectomía , Especies Reactivas de Oxígeno , Estudios Retrospectivos , Mamoplastia/métodos , Mastectomía Segmentaria/métodosRESUMEN
BACKGROUND: Long lags exist in adoption and uptake of evidence-based interventions into real-world clinical practice based on oncology clinical trial results. Implementation science (IS) is a distinct field of health services research that aims to understand the barriers related to adoption of evidence-based guidelines and research in clinical practice. METHODS: Use of IS study design, methods, and outcomes can be elusive to surgical oncologists despite the tremendous need for the application of IS to bridge the evidence-to-practice gap. This report describes key components of high-quality IS. RESULTS: Herein, we illustrate how IS can be used in surgical oncology practice. Examples from implementation of the breast cancer Short Stay Program (SSP) in Netherlands is used to illustrate IS methods. Specific funding and training opportunities in implementation science are described in detail. CONCLUSION: Use of IS in surgical oncology can help improve the uptake of evidence based medicine.
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Neoplasias de la Mama , Oncólogos , Neoplasias de la Mama/cirugía , Femenino , Humanos , Ciencia de la Implementación , Países Bajos , Proyectos de InvestigaciónRESUMEN
PURPOSE: Physician treatment preferences for early stage, estrogen positive breast cancer (ER + BC) patients were evaluated during the initial surge of the COVID-19 pandemic in the US when neoadjuvant endocrine therapy (NET) was recommended to allow safe deferral of surgery. METHODS: A validated electronic survey was administered May-June, 2020 to US medical oncologists (MO), radiation oncologists (RO), and surgeons (SO) involved in clinical trials organizations. Questions on NET use included practice patterns for locoregional management following NET. RESULTS: 114 Physicians from 29 states completed the survey-42 (37%) MO, 14 (12%) RO, and 58 (51%) SO. Before COVID-19, most used NET 'rarely' (49/107, 46%) or 'sometimes' (36, 33%) for ER + BC. 46% would delay surgery 2 months without NET. The preferred NET regimen was tamoxifen for premenopausal and aromatase inhibitor for postmenopausal women. 53% planned short term NET until surgery could proceed. Most recommended omitting axillary lymph node dissection (ALND) for one micrometastatic node after 1, 2, or 3 months of NET (1 month, N = 56/93, 60%; 2 months, N = 54/92, 59%; 3 months, N = 48/90, 53%). With longer duration of NET, omission of ALND decreased, regardless of years in practice, percent of practice in BC, practice type, participation in multidisciplinary tumor board, or number of regional COVID-19 cases. CONCLUSION: More physicians preferred NET for ER + BC during the pandemic, compared with pre-pandemic times. As the duration of NET extended, more providers favored ALND in low volume metastatic axillary disease. The Covid-19 pandemic affected practice of ER + BC; it remains to be seen how this may impact outcomes.
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Neoplasias de la Mama , COVID-19 , Axila , Neoplasias de la Mama/cirugía , Femenino , Humanos , Escisión del Ganglio Linfático , Terapia Neoadyuvante , Pandemias , SARS-CoV-2RESUMEN
BACKGROUND: The scientific rigor of the abstracts presented at the American Society of Breast Surgeons (ASBrS) annual meeting has not been recently evaluated. In this study, we sought to determine the rate at which abstracts presented at the 2017 and 2018 ASBrS meetings were published in peer-reviewed journals, and compared the rates with breast abstracts presented at the 2018 Society of Surgical Oncology (SSO) meeting. METHODS: Abstracts from the 2017 and 2018 ASBrS and 2018 SSO conferences were searched in PubMed for published manuscripts using the abstract title and/or first or last author. RESULTS: In 2017, 21.6% of the 268 abstracts presented at the ASBrS conference resulted in full publication, compared with 36.6% of the 273 abstracts presented at the 2018 ASBrS conference, resulting in a significant difference in the publication rate (p < 0.001). Of the 158 abstracts published from the 2017 and 2018 meetings, 75 (47.8%) were published in Annals of Surgical Oncology (ASO). There was no correlation between impact factor and time to publication. Oral presentations and quick shots were more likely to be published than poster presentations, and oral presentations were more likely to be published in higher-impact journals. The 2018 SSO meetings resulted in 54 of 111 (48.6%) breast abstracts leading to full publication. CONCLUSION: Approximately 29.2% of the abstracts presented at the ASBrS 2017 and 2018 conferences resulted in a published manuscript. A higher publication rate in higher impact journals for oral presentations indicates that the abstract review process properly stratifies the research.
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Sociedades Médicas , Cirujanos , Humanos , Estados UnidosRESUMEN
BACKGROUND: There is limited data evaluating mastectomy skin flap complications of nipple-sparing mastectomy (NSM) in patients with BRCA gene mutations. The purpose of this study was to identify factors associated with post-operative complications in BRCA mutation carriers undergoing NSM. METHODS: Following institutional review board approval, we interrogated a prospectively collected institutional database for patients undergoing NSM who tested positive for BRCA1/2 mutations. Patient characteristics, preoperative details, and complications were evaluated. Digital mammogram was used to estimate the breast volume. RESULTS: From August 2009 to December 2017, 59 patients (2 males) with BRCA1/2 mutations underwent 114 NSMs. Ninety-two (80%) were risk-reduction surgeries. Thirty-two (28%) underwent single-stage reconstruction (24 autologous). The overall complication rate was 26.3% (N = 30), and 10.5% (N = 12) underwent unanticipated reoperation. 8.8% (N = 10) had full-thickness skin flap necrosis, 10.5% (N = 12) nipple necrosis, and 4.4% (N = 5) full-thickness nipple necrosis. These complications were associated with larger breast volume (799.4 cc vs. 544.1 cc, p < 0.001) and greater body mass index (27.8 vs. 24.3, p < 0.001). By univariate analysis, body mass index and breast volume greater than 675 cc were associated with significantly higher complication rate (odds ratios 1.2 and 4.5 respectively, p = 0.001). CONCLUSIONS: This study confirms that NSM in BRCA1/2 mutation carriers is associated with complications in one in four patients. Utilizing the preoperative mammograms to estimate breast size may be more helpful than breast cup size in counseling preoperatively the risks of complications.
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Neoplasias de la Mama/cirugía , Mamografía/métodos , Mastectomía/efectos adversos , Mutación , Pezones/cirugía , Tratamientos Conservadores del Órgano/efectos adversos , Complicaciones Posoperatorias/diagnóstico , Adulto , Anciano , Proteína BRCA1/genética , Proteína BRCA2/genética , Neoplasias de la Mama/genética , Neoplasias de la Mama/patología , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Pronóstico , Estudios Prospectivos , Estudios Retrospectivos , Adulto JovenRESUMEN
BACKGROUND: The objective of this study is to assess surgeon-patient-centered decision-making (PCDM) strategies relative to surgeon and patient factors. METHODS: Approaches to PCDM were evaluated using a cross-sectional survey based on clinical vignettes assessing surgeon likeliness (0 = not at all likely, 100 = very likely) to utilize PCDM strategies. Data were analyzed using repeated-measures mixed-effects linear regression. Adjusted estimates are provided as least-squares mean (LSM) values. RESULTS: The final analytic sample consisted of 208 respondents (58.5% response rate); the majority of respondents were male (67.7%) and Caucasian (82.0%) with an average age of 51.6 years (standard deviation, SD = 9.9 years, range 34.0-78.0 years). Specialties included breast (18.9%), hepatopancreatobiliary (21.4%), and other (59.7%). Surgeons practicing at academic (versus nonacademic) hospitals were less likely to be directive (LSM: 66.2 vs. 70.3, p = 0.004), spend equal time discussing all treatment options (LSM: 77.9 vs. 82.3, p = 0.001), and make explicit treatment recommendations (LSM: 67.7 vs. 71.7, p = 0.005). Surgeons who specialized in breast cancer (versus other specialties), in practice 10+ years (versus < 10 years), and female (versus male) were more likely to spend time discussing all treatment options (LSM: 82.8 vs. 77.3; 81.6 vs. 78.6; and 82.1 vs. 78.0, all p < 0.05). Surgeons perceived patients who had blue-collar (versus white-collar) jobs as less likely to want active participation in decision-making (LSM: 62.9 vs. 65.6, p = 0.02). CONCLUSION: Surgeon approaches to PCDM varied based on a number of surgeon and patient characteristics. Further studies are needed to understand how surgeon PCDM strategies can be tailored to specific care contexts and patient needs.
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Neoplasias de la Mama , Atención Dirigida al Paciente , Cirujanos , Adulto , Anciano , Neoplasias de la Mama/cirugía , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Responsible opioid prescribing for postoperative pain control is critical. We sought to identify both patient and surgical factors associated with increased opioid use after breast-conserving surgery (BCS). METHODS: Patients (N = 316) undergoing BCS were surveyed to determine postoperative opioid use. Univariate and multivariate analyses were used to determine factors contributing to increased opioid use (highest quartile of use). All opioid prescriptions were converted to oral morphine equivalents (OME) for analysis. RESULTS: The mean opioid prescription was 33.2 OMEs. Fourteen patients (4.4%) did not receive a narcotic prescription at discharge. Seventy-eight patients (24.7%) did not take any opioids after discharge. Those in the highest quartile of use consumed more than 50 OMEs. Surgical factors, such as bilateral oncoplastic surgery (60.8 OMEs vs. 33.1 OMEs, p = 0.0001), axillary lymph node dissection (ALND) (61.5 vs. 30.5, p = 0.0003), and drain use (2 drains 71.1, 1 drain 40.4, no drains 26.2, p = 0.0001), were associated with higher opioid use. In a multivariate analysis, smoking, preoperative opioid use, bilateral oncoplastic surgery, high postoperative reported pain score, placement of at least one surgical drain, and receiving a discharge prescription greater than 150 OMEs were associated with the highest quartile of opioid use. CONCLUSIONS: Smoking, preoperative opioid use, bilateral oncoplastic surgery, ALND, use of surgical drains, high reported postoperative pain score, and receiving a higher OME discharge prescription are associated with higher postoperative opioid use. Given the wide variability of analgesic needs, these criteria should be used to guide the appropriate tailoring of opioid prescriptions.
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Analgésicos Opioides/uso terapéutico , Neoplasias de la Mama/cirugía , Prescripciones de Medicamentos/estadística & datos numéricos , Mastectomía Segmentaria/efectos adversos , Dolor Postoperatorio/tratamiento farmacológico , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/patología , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Dolor Postoperatorio/etiología , Dolor Postoperatorio/patología , Pronóstico , Estudios Prospectivos , Factores de RiesgoRESUMEN
Advancements in clinical practice usually require level one evidence from clinical trials that directly compare new approaches to standard of care. While clinical trials have provided data to guide advances in practices across surgical oncology, all too often accrual to clinical trials is slower than anticipated, and once results are presented and published, adoption in clinical practice is slow. Why and how can surgeons be successfully involved with clinical trials? An expert panel discusses the basic infrastructure of clinical trials, investigator-initiated trials, the National Clinical Trials Network, and opportunities for surgeon involvement. Two national clinical trials, NSABP B-51/RTOG 1304 and PROSPECT N1048, are discussed to highlight the role of the surgical oncologist.
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Ensayos Clínicos como Asunto , Oncólogos , HumanosRESUMEN
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.
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Neoplasias de la Mama/terapia , Comunicación Interdisciplinaria , Internado y Residencia , Oncología Médica/educación , Autoeficacia , Estudiantes de Medicina/psicología , Neoplasias de la Mama/cirugía , Femenino , Humanos , Masculino , Procedimientos Quirúrgicos Operativos/educación , Encuestas y CuestionariosRESUMEN
BACKGROUND: Intraoperative margin assessment for breast cancer patients undergoing segmental mastectomy (SM) enables identification of positive margins, with immediate excision of additional tissue to obtain negative margins. OBJECTIVE: The aim of this study was to determine the ability of digital breast tomosynthesis (DBT) to detect positive margins compared with an institution's standard extensive processing (SEP). METHODS: SM specimens underwent intraoperative SEP with two-dimensional (2D) imaging of the intact and sliced specimen, with review by a breast radiologist and gross assessment by a breast pathologist. Findings guided the surgeon to excise additional tissue. DBT images of intact specimens were prospectively obtained and retrospectively reviewed by a breast radiologist. A positive margin was defined as tumor at ink. RESULTS: Ninety-eight patients underwent 99 SMs. With SEP, 14 (14%) SM specimens had 19 positive margins. SEP did not detect 3 of the 19 positive margins, for a sensitivity of 84%, specificity of 78%, positive predictive value (PPV) of 11%, and negative predictive value (NPV) of 99%. Moreover, DBT did not detect 5 of the 19 positive margins, for a sensitivity of 74% (p > 0.05), specificity of 91% (p < 0.05), PPV of 21.5%, and NPV of 99%. With SEP guidance to excise additional tissue, six cases had final positive margins, with SEP not identifying three of these cases and DBT not identifying two. Pathology from the second surgery of these patients showed either no additional malignancy or only focal ductal carcinoma in situ. CONCLUSIONS: DBT is an accurate method for detecting positive margins in breast cancer patients undergoing SM, performing similar to institutional labor-intensive, intraoperative standard processing.
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Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/patología , Carcinoma Lobular/patología , Cuidados Intraoperatorios , Mamografía/métodos , Márgenes de Escisión , Medición de Riesgo/métodos , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/cirugía , Carcinoma Ductal de Mama/cirugía , Carcinoma Lobular/cirugía , Femenino , Estudios de Seguimiento , Humanos , Mastectomía , Persona de Mediana Edad , Invasividad Neoplásica , Pronóstico , Estudios Prospectivos , Estudios RetrospectivosRESUMEN
BACKGROUND: Few guidelines exist for an opioid prescription after breast surgical oncology (BSO) procedures. We sought to characterize opioid prescribing and use patterns by surgery type. METHODS: Patients (n = 332) undergoing BSO procedure were surveyed one week postoperatively for opioid use. The surgeons were surveyed about pain management preferences surgery type. CPT codes were collected for 2017 to calculate the amount of opioids used by surgery type relative to surgeon preference. RESULTS: Mean oral morphine equivalent (OME) preferred prescription for surgeons who did not tailor prescriptions by surgery type (n = 7, group A) was 177, whereas for those who did tailor (n = 10, group B) varied from 137 to 257 OME. There was a significant difference in opioid use by surgery type: 32 OME for segmental mastectomy (SM) ± sentinel lymph node dissection (SLND), 63 for SM + axillary lymph node dissection (ALND), 76 for total mastectomy (TM) ± SLND, 115 for TM + ALND (P < 0.001). Considering the type of surgeries performed group A prescribers would have 229190 unused OME and group B would have 230826 in 1 year. CONCLUSION: Wide variation in opioid use by BSO procedure type was noted with substantial unused OME regardless ofprescribing preference. Evidence-based guidelines are needed to tailor analgesic prescriptions according to the need.
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Analgésicos Opioides/administración & dosificación , Neoplasias de la Mama/cirugía , Dolor en Cáncer/tratamiento farmacológico , Oncólogos/estadística & datos numéricos , Dolor Postoperatorio/tratamiento farmacológico , Pautas de la Práctica en Medicina/estadística & datos numéricos , Cirujanos/estadística & datos numéricos , Neoplasias de la Mama/fisiopatología , Femenino , Humanos , Escisión del Ganglio Linfático/efectos adversos , Escisión del Ganglio Linfático/métodos , Mastectomía/efectos adversos , Mastectomía/métodos , Oncólogos/psicología , Manejo del Dolor/métodos , Percepción , Cirujanos/psicologíaRESUMEN
We evaluated 328 patients (34.8% African American [AA]; 65.2% White American [WA]) with hormone receptor-positive, HER2/neu-negative breast cancer. Mean age (60 years); mean tumor size (1.6 and 1.7 cm for AA and WA, respectively) were similar, and mean BMI was higher for AA (33 vs 29.8; P = 0.001). Recurrence score (RS) distribution was similar- 8.3% AA and 5.9% WA with high RS (≥31). No significant differences were observed in delivery of chemotherapy stratified by score. With median follow-up 27.2 months for AA and 33.4 months for WA, distant recurrence occurred in 1.0% and 1.6%, respectively (P = 1). Our results suggest comparable RS utility in AA and WA patients.
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Neoplasias de la Mama/genética , Neoplasias de la Mama/patología , Transcriptoma , Adulto , Negro o Afroamericano/genética , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/terapia , Femenino , Regulación Neoplásica de la Expresión Génica , Humanos , Persona de Mediana Edad , Recurrencia Local de Neoplasia/genética , Recurrencia Local de Neoplasia/patología , Pronóstico , Receptor ErbB-2/metabolismo , Población Blanca/genéticaRESUMEN
Molecular genomic testing provides clinicians with both prognostic and (sometimes) predictive information that can help individualize treatment and decrease the risk of over- or under-treatment. We review the genomic tests that are currently available for clinical use in management of breast cancer, discuss ongoing research related to validating and expanding their utility in different patient populations, and explain why it is important for surgeons to know how to incorporate these tools into their clinical practice in order to individualize patient treatment, reduce unnecessary morbidity, and, accordingly, improve outcomes.
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Biomarcadores de Tumor/genética , Neoplasias de la Mama/genética , Toma de Decisiones , Pruebas Genéticas/métodos , Selección de Paciente , Cirujanos , Transcriptoma , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/terapia , Femenino , Genómica/métodos , Humanos , Medicina de Precisión , Pronóstico , Medición de RiesgoRESUMEN
INTRODUCTION: The 21-gene expression profile [Oncotype DX Recurrence Score (RS)] stratifies benefit from adjuvant chemotherapy in hormone receptor (HR)-positive, HER2/neu-negative, node-negative breast cancer. It is not routinely applied to predict neoadjuvant chemotherapy (NACT) response; data in diverse patient populations also are limited. We developed a statistical model based on standard clinicopathologic features to identify high-risk cases (RS > 30) and then evaluated ability of predicted high RS to predict for NACT downstaging. METHODS: Primary surgery patients with Oncotype DX RS testing 2012-2016 were identified from a prospectively-maintained database. A RS predictive model was created and applied to a dataset of comparable NACT patients. Response was defined as tumor size decrease ≥ 1 cm. RESULTS: Of 394 primary surgery patients-60.4% white American; 31.0% African American-RS distribution was similar for both groups. No single feature reliably identified high RS patients; however, a model accounting for age, HR expression, proliferative index (MIB1/Ki67), histology, and tumor size was generated, with receiver operator area under the curve 0.909. Fifty-six NACT patients were identified (25 African American). Of 21 cases with all relevant clinicopathology, 14 responded to NACT and the model generated high-risk RS in 14 (100%); conversely, of 16 cases generating high-risk RS, only 2 did not respond. CONCLUSIONS: Predictive modelling can identify high RS patients; this model also can identify patients likely to experience primary tumor downstaging with NACT. Until this model is validated in other datasets, we recommend that Oncotype-eligible patients undergo primary surgery with decisions regarding chemotherapy made in the adjuvant setting.